Beyond Nutrient Deficiency-Opportunities to Improve Nutritional Status and Promote Health Modernizing DRIs and Supplementation Recommendations.

The US Dietary Guidelines for Americans (DGA) provide dietary recommendations to meet nutrient needs, promote health, and prevent disease. Despite 40 years of DGA, the prevalence of under-consumed nutrients continues in the US and globally, although dietary supplement use can help to fill shortfalls. Nutrient recommendations are based on Dietary Reference Intakes (DRIs) to meet the nutrient requirements for nearly all (97 to 98 percent) healthy individuals in a particular life stage and gender group and many need to be updated using current evidence. There is an opportunity to modernize vitamin and mineral intake recommendations based on biomarker or surrogate endpoint levels needed to 'prevent deficiency' with DRIs based on ranges of biomarker or surrogate endpoints levels that support normal cell/organ/tissue function in healthy individuals, and to establish DRIs for bioactive compounds. We recommend vitamin K and Mg DRIs be updated and DRIs be established for lutein and eicosapentaenoic and docosahexaenoic acid (EPA + DHA). With increasing interest in personalized (or precision) nutrition, we propose greater research investment in validating biomarkers and metabolic health measures and the development and use of inexpensive diagnostic devices. Data generated from such approaches will help elucidate optimal nutrient status, provide objective evaluations of an individual's nutritional status, and serve to provide personalized nutrition guidance.

The significance of a thickened endometrial echo in asymptomatic postmenopausal patients.

OBJECTIVE: The purpose of this study was to evaluate the significance of a thickened endometrial echo in an asymptomatic, postmenopausal patient. STUDY DESIGN: A retrospective review was conducted of all women who underwent transvaginal ultrasonography between January 2003 and August 2008, were found to have an endometrial thickness of at least 5mm and were subjected to endometrial sampling. RESULTS: Sixty-five postmenopausal women, without vaginal bleeding underwent ultrasonographic evaluation with subsequent endometrial sampling. The mean endometrial stripe thickness was 9.7 mm (range: 5.4-22). Four (6.2%) cases of simple/complex hyperplasia were identified and two (3.1%) cases of atypical hyperplasia were diagnosed. Zero (0%) specimens were identified as adenocarcinoma. Twenty-eight (43.1%) polyps and eleven (16.9%) leiomyomata were identified. CONCLUSION: The use of transvaginal sonography as a screening tool in this population is not validated and need not trigger routine evaluation.

Personal responsibility and obesity: a constructive approach to a controversial issue.

The concept of personal responsibility has been central to social, legal, and political approaches to obesity. It evokes language of blame, weakness, and vice and is a leading basis for inadequate government efforts, given the importance of environmental conditions in explaining high rates of obesity. These environmental conditions can override individual physical and psychological regulatory systems that might otherwise stand in the way of weight gain and obesity, hence undermining personal responsibility, narrowing choices, and eroding personal freedoms. Personal responsibility can be embraced as a value by placing priority on legislative and regulatory actions such as improving school nutrition, menu labeling, altering industry marketing practices, and even such controversial measures as the use of food taxes that create healthier defaults, thus supporting responsible behavior and bridging the divide between views based on individualistic versus collective responsibility.

Regulatory Perspective of the USDA on the Use of Antimicrobials and Inhibitors in Foods.

The Food Safety and Inspection Service (FSIS) is directly involved in the changes occurring in food ingredient use. FSIS responds to petitions from industry, trade groups, academia, and other research organizations for the use of new ingredients and the new use of existing ingredients in meat and poultry products. The agency confirms the safety and evaluates the technical efficacy of food ingredients intended for use in meat or poultry products. While FSIS maintains its own list of approved substances separate from that maintained by the Food and Drug Administration (FDA), FSIS seeks guidance and concurrence from FDA on ingredient approvals. Several trends have spurred the creativity in ingredient use, viz., globalization, labeling reform, a "marketing quality" concept, and industry and consumer concerns for safe, healthy ingredients, all of which translates to safe and healthy foods. The trend for safe and healthy foods is seen in the increased interest in the use of preservatives, particularly antimicrobial agents. To date, only a limited number of antimicrobial substances have been approved for direct use in meat and poultry products. However, there is a growing interest in antibacterial substances produced by certain strains of bacteria, e.g., nisin, a bacteriocin, for use in meat and poultry products. The use and application of these ingredients will require an integrated review by both FSIS and FDA before applications to meat and poultry are possible.