Exposure to Holocaust is associated with chronic morbidity in older adults-Results from national health and nutrition surveys.

BACKGROUND: Although studies have suggested that Holocaust survivors are more likely than their non-Holocaust-exposed counterparts to suffer from mental and chronic morbidity, methodology differences and potential confounders often compromise result replicability and external validity. We examined associations between Holocaust exposure and chronic morbidity, as well as overall risk of mortality. METHODS: Sociodemographic, health-related behavior and nutritional-intake data from two representative National Health and Nutrition Survey Ages 65 and Over-the 2005-2006 MABAT ZAHAV 1 (MZ1) and the 2014-2015 MZ2, including face-to-face interviews and anthropometric measurements-were analyzed. Demographic, health, nutritional and lifestyle characteristics, and exposure to the Holocaust were self-reported. Longitudinal data on overall mortality were obtained by linking the MZ1 population to the population registry dataset. Associations between Holocaust exposure and prevalence of chronic morbidity and risk factors were estimated by multivariable logistic regression analyses, and to risk of overall mortality by Cox regression analysis, both adjusted to significant covariates. RESULTS: Among 2096 study participants aged 75.7 ± 6.1 years, 47.0% male, 518 were Holocaust survivors. In the fully adjusted model, Holocaust exposure was associated with increased prevalence of heart disease (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.07-1.83), metabolic syndrome (OR 2.28, CI 1.23-4.21), and stroke (OR 1.77, CI 1.17-2.69), but not cancer or osteoporosis. Holocaust exposure did not substantially affect the overall risk of mortality (hazard ratio 1.10, CI 0.92-1.32). CONCLUSIONS: Further research is needed to understand the mechanisms governing long-term outcomes of exposure to acute physical or mental trauma.

Attention-deficit hyperactivity disorder is associated with disordered eating in adolescents.

AIM: Attention-deficit hyperactivity disorder (ADHD) and disordered eating (DE) are both highly prevalent among adolescents, but their relationship is understudied. This study examines their possible association in a nationally representative sample of adolescents. METHODS: Participants in the Israeli Youth Health and Nutrition Survey (2015-2016), a cross-sectional, school-based study, completed self-administered questionnaires, including the SCOFF questionnaire, and underwent anthropometric measurements. An affirmative reply to at least two SCOFF items was considered a DE case. Multivariable logistic regression evaluated the ADHD-DE association and the associations between ADHD and individual SCOFF items, controlling for age, sex, socioeconomic status, and body mass index. RESULTS: Of 4616 participants (12-18 years, 50.2% male), 654 reported an ADHD diagnosis. DE prevalence among ADHD adolescents was significantly higher than the non-ADHD group (50.2% vs. 43.9%, p = 0.003). Controlling for potential covariates, the association between ADHD and DE remained significant (OR = 1.409; 95% CI: 1.170-1.697), as did associations between ADHD and three SCOFF items. No difference in DE prevalence was found between stimulant-treated (n = 287) and untreated (n = 326) adolescents with ADHD. CONCLUSION: Adolescents with ADHD are more likely to experience DE. As DE can herald an imminent eating disorder, early identification is crucial. Further studies are needed to determine the ADHD-DE relationship's causality. IMPACT: Disordered eating (DE) and attention-deficit hyperactivity disorder (ADHD) are common among adolescents, and significantly affect health and well-being. This study examined the association between ADHD and DE in adolescents using the SCOFF questionnaire. Following adjustment for sociodemographic variables and BMI z-score, ADHD was associated with a 41% increased odds for DE. This study established the association between ADHD and DE, using a well-known questionnaire, in a large, nationally representative sample of adolescents. Monitoring eating behaviors and attitudes among adolescents with ADHD should be a priority, to minimize the risk of developing an eating disorder and its harmful consequences.

Attention-deficit hyperactivity disorder is associated with relatively short stature among adolescents.

AIM: To estimate the association between attention-deficit hyperactivity disorder (ADHD) and relatively short stature (RSS) among adolescents. METHODS: Participants in the Israeli Youth Health and Nutrition Survey (2015-2016), a cross-sectional school-based study, completed self-administered questionnaires and underwent anthropometric measurements. Height z-score < -0.7 (<25th percentile) was defined as RSS. Multivariable logistic regression analyses assessed the relation between ADHD and RSS, controlling for age, sex, body mass index (BMI) and socioeconomic status (Basic Model), and also for lifestyle factors such as physical activity, sleep duration, dietary patterns and intakes. RESULTS: Of 4173 participants (11-18 years, 50.2% males), 654 self-reported ever being diagnosed with ADHD; 3519 participants were controls. Overweight (BMI z-score ≥1) and pubertal status were not different among groups. According to the Basic Model, ADHD was significantly associated with RSS (OR 1.25, 95% CI 1.03-1.50), and even after adjustments for lifestyle factors and dietary intake (OR 1.28, 95% CI 1.03-1.58). Stimulant-treated ADHD adolescents had similar height z-scores and lifestyles as those not treated with stimulants. CONCLUSION: Attention-deficit hyperactivity disorder was associated with RSS. Height deficit may be intrinsic to ADHD or its pharmacotherapy, rather than a consequence of lifestyle alone. Further studies are needed to determine the causal relationship between ADHD and short stature.

Wastewater-derived organic contaminants in fresh produce: Dietary exposure and human health concerns.

Irrigation with reclaimed wastewater is a growing practice aimed at conserving freshwater sources, especially in arid and semiarid regions. Despite the apparent advantages to water management, the practice of irrigation with reclaimed wastewater exposes the agroenvironment to contaminants of emerging concern (CECs). In this report, we estimated the unintentional dietary exposure of the Israeli population (2808 participants) to CECs from consumption of produce irrigated with reclaimed wastewater using detailed dietary data obtained from a National Health and Nutrition Survey (Rav Mabat adults; 2014-2016). Human health risk analyses were conducted based on acceptable daily intake (ADI) and threshold of toxicological concern (TTC) approaches. The highest unintentional exposure to wastewater-borne CECs was found to occur through the consumption of leafy vegetables. All analyzed CECs exhibited hazard quotients <1 for the mean- and high-exposure scenarios, indicating no human health concerns. However, for the extreme exposure scenario, the anticonvulsant agents lamotrigine and carbamazepine, and the carbamazepine metabolite epoxide-carbamazepine exhibited the highest exposure levels of 29,100, 27,200, and 19,500 ng/person (70 kg) per day, respectively. These exposure levels exceeded the TTC of lamotrigine and the metabolite epoxide-carbamazepine, and the ADI of carbamazepine, resulting in hazard quotients of 2.8, 1.1, and 1.9, respectively. According to the extreme estimated scenario, consumption of produce irrigated with reclaimed wastewater (leafy vegetables in particular) may pose a threat to human health. Minimizing irrigation of leafy vegetables using reclaimed wastewater and/or improving the quality of the reclaimed wastewater using an advanced treatment would significantly reduce human dietary exposure to CECs.

Non-Dairy Animal Protein Consumption Is Positively Associated with Overweight and Obesity in Israeli Adolescents.

Protein consumption apparently plays a role in weight control. This cross-sectional study examined the association of protein consumption in Israeli adolescents with overweight/obesity. 7th−12th grade students participating in a national school-based survey (2015−2016) completed self-administered questionnaires, including a food frequency questionnaire, and height and weight measurements (n = 3443, 48% males, 15.2 ± 1.6 years). WHO growth standards served to define weight status. Intakes of total protein and protein source were calculated. Multivariable logistic regression analyses evaluated associations with overweight/obesity (BMI z-score ≥ 1), adjusting for possible covariates. Total protein intake (median (IQR)) was 62.5 (45.5, 85.7) g/d, accounting for 12.0 (10.5, 13.6) percent of daily energy. Of participants, 31.4% were overweight/obese. In multivariable models, overweight/obesity was positively associated with incremental increases of 10 g/d in total protein intake (OR = 1.07, 95% CI: 1.02−1.12, p < 0.01), total animal protein intake (OR = 1.05, 95% CI: 1.01−1.10, p = 0.026), and non-dairy animal protein intake (OR = 1.06, 95% CI: 1.01−1.11, p = 0.029). No associations were found with plant or dairy protein intake. These associations remained when protein intake was reported as a percentage of daily energy and when overweight and obesity were analyzed individually. High daily protein intakes, principally from non-dairy animal sources, were positively associated with overweight/obesity in adolescents. Additional studies are needed to establish causality of these findings.

Comparisons in polypharmacy over a decade in community-dwelling older adults-findings from Israel national health and nutrition surveys.

BACKGROUND: Polypharmacy increases with age and is associated with serious health and economic costs. This study reports changes over a decade in medication-use patterns and polypharmacy, in Israeli community-dwelling older adults aged ≥ 65 years. METHODS: Demographic and health data from two representative national health cross-sectional surveys - MABAT ZAHAV 1 (MZ1) in 2005-2006, and MZ2 in 2014-2015 were analyzed. Polypharmacy was defined as use of ≥ 5 medications. Risk factors for polypharmacy were estimated by multivariable logistic regression with adjusted odds ratios (aOR) and their 95% confidence intervals (CI). RESULTS: Self-reported data on medications taken were available for 1647 participants (91.5%) in MZ1, and for 833 participants (80.2%) in MZ2, 55% women, and about 20% aged ≥ 80, in both surveys. The prevalence of polypharmacy was significantly lower in MZ2 than in MZ1: 64.2% versus 56.3%, p = .0001; with an aOR (95%CI) of 0.64 (0.52, 0.80). The most commonly taken drugs were for hypertension (27.0%, 25.3%), dyslipidemia (9.7%, 12.4%) and anticoagulation (9.2%, 9.8%). For approximately 10% of drugs, indications were either unknown or incorrect. Polypharmacy was significantly associated with poor self-health assessment 2.47 (1.99, 3.06), ≥ 4 versus 1-3 chronic illnesses 6.36 (3.85, 10.50), and age ≥ 80 versus younger 1.72 (1.32, 2.24). Similar associations were observed with major polypharmacy of ≥ 8 medications. CONCLUSION: Polypharmacy, although reduced in the last decade, requires constant attention, especially concerning lack of knowledge of indications which leads to poor adherence and adverse side effects. Health-care teams should carry out regular medicine reconciliation in at-risk elderly patients.

Milk and dairy consumption is positively associated with height in adolescents: results from the Israeli National Youth Health and Nutrition Survey.

PURPOSE: Milk consumption is associated with increased height primarily in early childhood. However, in adolescents, data are scarce with inconsistent results. Since height is a proxy for overall health and well-being, this study evaluated the association of dairy intake with height in adolescents. METHODS: Students in 7th-12th grades, participating in the 2015-2016 Israeli Health and Nutrition Youth Survey, a school-based cross-sectional study, completed self-administered questionnaires, including a semi-quantitative food frequency questionnaire (n = 3529, 48% males, 15.2 ± 1.6 years). Anthropometric measurements were also performed. Dairy servings were calculated as the calcium equivalent of 1 cup of milk, and consumption was divided into four categories from very low (< 1 serving/day) to high (3 + servings/day). BMI- and Height-for-age z scores (HAZs) were calculated according to WHO growth standard; relatively short stature (RSS) was defined as HAZ < - 0.7 SD (< 25th percentile). Multivariable linear and logistic regression analyses were performed to evaluate the association of dairy intake with HAZ and prevalence of RSS, respectively. RESULTS: Median consumption of dairy products was 2 servings/day, 1.4 from unsweetened products (milk, cheese and yogurt). Controlling for age, sex, BMI-z-score and socioeconomic status, each increment of unsweetened dairy intake was associated with on average 0.04 higher HAZ (equivalent to 0.3-0.4 cm, p < 0.05), and with reduced risk for RSS: OR 0.90, 95%CI: 0.84, 0.97, p < 0.01. No such associations were found with sweetened dairy products. CONCLUSION: Consumption of unsweetened dairy products (3-4 servings/day) appears to contribute to achieving growth potential in adolescents. Intervention studies are necessary to determine the causal relationship between dairy intake and linear growth.

Current use of nutrition facts tables and attitudes towards new red and green front-of-package labels among Israeli consumers.

Front-of-package labels (FOPL) are designed to simplify nutrition information and to help consumers make healthier food choices. The Israeli government has implemented new regulations requiring mandatory red warning FOPL for high levels of sodium, sugar, or saturated fats. A voluntary green positive FOPL for products fitting the national nutritional recommendations was concurrently encouraged. In order to characterise adult consumers' current use of Nutrition Facts Tables (NFT) and their attitudes towards the new FOPL, a nationally representative cross-sectional telephone survey was conducted. Most of the 1,042 survey respondents reported frequent NFT use (76.2%) and intentions to purchase fewer red-labelled (81.1%) and more green-labelled products (85.0%). Consumers with higher BMI and lower education expressed higher intentions to use the new FOPL, but not higher current use of NFT. This finding suggests that these high-risk groups, which the new labels are meant to target, may indeed benefit from the new policy.

Dietary Patterns among Adolescents Are Associated with Growth, Socioeconomic Features, and Health-Related Behaviors.

Dietary patterns (DPs), usually established in adolescents, are important modifiable risk factors in the etiology of malnutrition and chronic diseases. This study aimed to identify DPs of adolescents and examine their associations with growth, sociodemographic, and lifestyle characteristics. A nationally representative, school-based, cross-sectional study was conducted in Israeli adolescents aged 11-18 years during 2015-2016. A self-administered survey queried sociodemographics, health behaviors, and diet. Weight and height were measured, and WHO height z-scores and BMI cutoffs were calculated. Food frequency questionnaire data were analyzed using principal components analysis (PCA) to identify DPs. Associations between growth, lifestyle, and sociodemographic characteristics and DPs were modeled using multivariable logistic regressions. A total of 3902 adolescents (46% males, mean age 15.2 ± 1.6 years) completed the survey. PCA identified five DPs, accounting for 38.3% of the total variance. The first two prominent DPs were the 'plant-based food' DP, which was associated with the female sex, higher socioeconomic status, overweight/obesity, and healthy lifestyle and the 'junk food' DP, which was associated with lower SES, unhealthy lifestyle, and lower height z-scores. Our results elucidate major DPs that strongly correlate with lifestyle risk behaviors and suboptimal growth among adolescents. Implementing screening for DPs should be further examined to identify higher risk health factors among youth.

Energy Intake Is Highly Associated with Handgrip Strength in Community-Dwelling Elderly Adults.

BACKGROUND: Handgrip strength (HGS) is used to assess muscle strength, which is an important indicator of health status in older adults. OBJECTIVE: We evaluated associations of demographic, anthropometric, clinical, and nutritional factors with muscle strength in community-dwelling elderly adults. METHODS: This population-based cross-sectional study employed the 2014-2015 Israeli Health and Nutrition Survey in the Elderly (n = 1039, age ≥65 y, 46.7% males, 9.9% Arabs). Trained personnel performed face-to-face interviews that focused on health and nutrition status, as well as anthropometric measurements and examinations. HGS was measured in the dominant hand 3 times using a digital grip strength dynamometer; the highest result was reported. Dietary intake data were collected using single-day 24-h recall. Multivariable logistic regressions were used to explore factors associated with low HGS (<27 kg for men and <16 kg for women). RESULTS: HGS measurements were completed by 704 participants. Following adjustment for several factors, higher prevalence of low HGS was significantly associated with age (OR: 1.14; 95% CI: 1.11, 1.18), whereas decreased prevalence was associated with higher levels of education (OR: 0.55; 95% CI: 0.32, 0.94) and meeting physical activity recommendations (OR: 0.53; 95% CI: 0.31, 0.88); P < 0.05 for all. Incremental increases of 100 kcal/d in energy intake and of 1 cm in midarm circumference were associated with decreased prevalence of low HGS (OR: 0.95; 95% CI: 0.91, 0.99 and OR: 0.91; 95% CI: 0.85, 0.97, respectively; P < 0.01 for both). Associations were not found of low HGS with ethnicity, comorbidity, BMI, smoking, or alcohol consumption or with protein, carbohydrate, or fat intakes. CONCLUSION: Energy intake, physical activity, midarm circumference, and education are associated with HGS in elderly Israeli adults. Further cohort studies are necessary to assess possible causal relations between these factors and HGS. Modifiable factors should be targeted in planning public health strategies for promoting a healthy aging population.

Trends in the adherence to the Mediterranean diet in Israeli adolescents: results from two national health and nutrition surveys, 2003 and 2016.

PURPOSE: To compare the adherence to the Mediterranean diet (MD) in Israeli adolescents in 2003-4 and in 2015-6, and associated factors. METHODS: Adolescents (aged 11-19 years) from two cross-sectional, school-based, nationally representative surveys, Mabat Youth I (2003-4, n 5005) and II (2015-6, n 3906), completed self-administered questionnaires on food frequency, eating behaviors and lifestyle. The Mediterranean Diet Quality Index for Children and Adolescents (KIDMED index), derived from these questionnaires, was used; higher scores indicate better diet quality. The samples comprised eight subgroups, according to population group (Jews/Arabs), school level (middle/high) and sex. RESULTS: The percentages with poor, average and good KIDMED scores were 11.6, 45.3 and 43.1% in 2015-6, compared to 25.5, 55.2 and 19.3%, respectively, in 2003-4. Significant improvement was seen in all subgroups (all p < 0.001), and was attributed to increased consumption of fruits, vegetables, cereals, dairy products, and decreased negative eating behaviors. In Mabat Youth II, physical activity at least 1 h/day was positively associated with good KIDMED scores among Jewish adolescents; dieting and sleeping at least 7 h/day were associated with good MD adherence in Jewish boys; always/often reading food labels predicted good MD adherence among Jewish boys and Arab girls. Overweight and obesity were negatively associated with better KIDMED scores in Jewish boys. CONCLUSION: MD adherence in Israeli adolescents has improved overall. The changes in MD components and the associated behavioral factors indicate the initiatives, relevant to the different subgroups, that are necessary to promote healthier nutrition and lifestyles.

Ultra-processed food targets bone quality via endochondral ossification.

Ultra-processed foods have known negative implications for health; however, their effect on skeletal development has never been explored. Here, we show that young rats fed ultra-processed food rich in fat and sugar suffer from growth retardation due to lesions in their tibial growth plates. The bone mineral density decreases significantly, and the structural parameters of the bone deteriorate, presenting a sieve-like appearance in the cortices and poor trabecular parameters in long bones and vertebrae. This results in inferior mechanical performance of the entire bone with a high fracture risk. RNA sequence analysis of the growth plates demonstrated an imbalance in extracellular matrix formation and degradation and impairment of proliferation, differentiation and mineralization processes. Our findings highlight, for the first time, the severe impact of consuming ultra-processed foods on the growing skeleton. This pathology extends far beyond that explained by the known metabolic effects, highlighting bone as a new target for studies of modern diets.

Vitamin E status among bariatric surgery patients: a systematic review.

Vitamin E, a fat-soluble vitamin with antioxidant properties, is thought to modulate enzymes involved in signal transduction, affect gene expression, and have immunomodulatory capabilities. Severe vitamin E deficiency is associated with neuronal disorders, impaired immune response, hemolytic anemia, and oxidative-based disorders. Patients who undergo bariatric surgery (BS), especially malabsorptive procedures, are at greater risk of developing fat-soluble vitamin deficiencies. Current data on vitamin E statuses among BS patients are limited. Therefore, this systematic review has summarized the scientific literature on vitamin E and examined its status among patients following different types of BS. Searches of the MEDLINE and Embase databases were performed, followed by hand-searching of reference lists from all relevant papers. Of the 671 initially identified articles, 24 met the inclusion criteria: 1 study on adjustable gastric banding patients (n = 21), 4 studies on sleeve gastrectomy patients (n = 173), 12 studies on Roux-en-Y gastric bypass patients (n = 689) and 12 studies on biliopancreatic diversion with or without duodenal switch (n = 799) or single anastomosis duodeno-ileal bypass with sleeve gastrectomy patients (n = 163). Results suggest that patients who undergo malabsorptive procedures are at higher risk of developing vitamin E deficiency, although clinical manifestations of vitamin E deficits following BS are rarely documented. The optimal dose of vitamin E supplementation required for prevention of deficiency or for treatment following BS has yet to be established. Future observational and intervention studies are needed to bridge the gaps in existing knowledge.

Nutritional Assessment and Preparation for Adult Bariatric Surgery Candidates: Clinical Practice.

Bariatric surgery (BS) has proven to be highly efficacious in the treatment of obesity and its comorbidities. However, careful patient selection is critical for its success. Thus, patients should undergo medical, behavioral, and nutritional assessment by a multidisciplinary team. From the nutritional point of view, BS candidates should undergo nutritional assessment, preparation, and education by a registered dietitian in the preoperative period. Currently, detailed specified and comprehensive information on these topics is lacking. The present narrative review aimed to summarize the available literature concerning both the preoperative nutritional assessment components and the preoperative nutritional preparation and education components of patients planning to undergo BS. Current literature indicates that proper management before BS should include a comprehensive nutritional assessment, in which it is advisable to perform a clinical interview to assess patients' medical background, weight management history, eating patterns and pathologies, oral health, physical activity habits, nutritional status, supplementation usage, BS knowledge, surgery expectations and anthropometric measurements. Nutritional preparation and educational strategies should include an individualized preoperative weight-loss nutrition program, improvement of glycemic control, micronutrients deficiencies correction, eating and lifestyle habits adaptation, physical activity initiation, and strengthening knowledge on obesity and BS. At this stage, more well-designed intervention and long-term cohort studies are needed in order to formulate uniform evidence-based nutritional guidelines for patients who plan to undergo BS, including populations at higher nutritional risk. Moreover, postoperative outcomes of presurgical nutritional intervention programs should be studied.

Menarche at an Earlier Age: Results from Two National Surveys of Israeli Youth, 2003 and 2016.

STUDY OBJECTIVE: To assess emergent changes in the age at menarche and investigate associated factors in Israeli adolescents in 2003 and 2016. DESIGN: Cross-sectional study. SETTING: Two national representative school-based surveys (first and second "Mabat Youth"). PARTICIPANTS: Both surveys included female students in 7th-12th grades (ages 11-19 years). The first (N = 3328) was conducted between the years 2003 and 2004, and the second (N = 2535) from 2015 to 2016. INTERVENTIONS: The survey questionnaire was self-administered and anthropometric measurements were performed by trained personnel. MAIN OUTCOME MEASURES: The current age at menarche in Israeli girls was determined and independent factors (demographic, clinical, and lifestyle) examined. Changes that occurred since the past national survey more than a decade ago were documented. RESULTS: The estimated median age at menarche declined from 13.0 (interquartile range, 12.0-14.0) years in 2003-2004 to 12.5 (interquartile range, 12.0-13.0) years in 2015-2016 (P < .0001). Jewish girls reached menarche earlier than Arab girls, but both populations experienced a similar downward trend in the past approximately 14 years. Greater body mass index, higher socioeconomic status, and immigrant status were associated with younger menarche onset (P < .001). Age at menarche remained lower in 2015-2016 vs 2003-2004, even after adjustment for these potential confounders, with a high hazard ratio (HR), which decreased as a function of survival time (t): HRt = 15.417 × 0.813t. CONCLUSION: This study confirms the decline in age at menarche in Israel. Findings were associated with body mass index and population group but also indicated that other factors are likely involved.

Long term nutritional and growth outcomes of children completing an intensive multidisciplinary tube-feeding weaning program.

BACKGROUND & AIMS: Children on long-term tube-feeding often need special treatment for oral feeding transitioning. Rapid tube-weaning programs usually result in short-term reductions in food intake and weight loss. This study examined the long-term effects of a "Graz-model" based weaning program on nutritional status and growth. METHODS: Children aged 0.5-13.0 years on long-term enteral nutritional support (ENS) participated in a three-week multidisciplinary weaning treatment. Data were collected at baseline, after completing the program, and at six and 12 months. Height/length, weight and BMI z-scores were determined according to the WHO growth standards. Energy and protein intake were assessed and presented as % of recommended daily allowance (RDA) values. RESULTS: Study participants (n = 58) were 64% male. Four children did not complete the three-week program due to acute illnesses. Complete weaning (from 100% ENS to 100% oral) was achieved in 22 children and partial weaning (at least 80% reduction of ENS) in 23 children. No demographic or clinical success predictors were identified. Thirty of the 45 weaned children completed the 12-month follow-up. A significant reduction in energy intake was observed at the three-week time-point [mean (SE): 56 (5.8)% versus 80 (4.7)%, p = 0.001]. This was followed by improvements in eating skills leading to energy intake at 12 months which did not significantly differ from baseline (p = 0.392). Mean (SE) baseline protein intake was 187 (13.0) %RDA. No significant difference from baseline were noted at 12 months (p = 0.301). Estimated mean (SD) height-, weight- and BMI z-scores at baseline were -2.11(0.28), -1.48(0.25), -0.13(0.31), respectively. No significant differences in growth data were observed over time. CONCLUSIONS: Short-term reductions in nutritional intake and body weight observed after an intensive weaning program were reversible, and growth patterns were stable over 12 months. Further follow-up is recommended to ensure continued positive development in these children.

Vitamin K-what is known regarding bariatric surgery patients: a systematic review.

Vitamin K, a fat-soluble vitamin, is involved in blood coagulation, bone mineralization, inhibition of vascular calcification, and regulation of numerous enzyme systems. Patients who undergo bariatric surgery (BS), especially procedures that involve a malabsorptive component, are prone to develop vitamin K deficiency (VKD). The causes of VKD include decreased absorptive surface areas, steatorrhea, bacterial overgrowth, marked reduction of carriers of vitamin K, decrease in vitamin K intake, and modifications of gut microbiota. Data on vitamin K status among BS patients are scarce and the strength of evidence supporting vitamin K supplementation is weak. Thus, this systematic review summarized the scientific literature on vitamin K and examined the status among patients before and after BS, as well as among pregnant women with a history of BS. A MEDLINE/Pubmed and Embase electronic search was performed. After a thorough screening of 204 titles, 19 articles were selected by 2 independent reviewers. Five studies on BS candidates (n = 750), 12 studies after BS (n = 1442), and 4 studies on pregnant woman after BS (n = 83, of them n = 7 from case reports) were included. Results of the current review suggest that patients who undergo major malabsorptive surgeries are at a higher risk of developing VKD and should be better monitored. At this point, it is still unclear whether supplementation of vitamin K is required, and what oral dose or vitamer type should be used to normalize serum levels after different types of bariatric procedures. It should be noted that the current protocols for VKD treatment are still experiential in these patients. It is also unknown at what intervals screening tests for vitamin K should be performed and what assay is most appropriate for screening purposes. Future studies are needed to answer these unresolved issues.

Rapid Weight Loss in Competitive Judo and Taekwondo Athletes: Attitudes and Practices of Coaches and Trainers.

Fasting, skipping meals, and dehydration are common methods of rapid weight loss used prior to competition in weight category sports. This study examines coaches' attitudes, perceptions, and practices regarding rapid weight loss among judo and taekwondo athletes. A convenience sample of experienced coaches and trainers (n = 68) completed structured questionnaires. Participants in this study were 33.8 ± 9.3 years old; 57 were males and 11 were females; and 59% were certified coaches, with 71% reporting over 20 years of involvement in sports and 68% having more than 10 years of teaching experience. The majority (90%) reported that they usually supervised athletes through the weight loss process. Interventions for weight loss began at 12.7 ± 1.9 years of age, with a recommended precompetition weight loss duration of 16.2 ± 8.2 days and an average reduction of 1.5 ± 0.7 kg. The majority of the responders (92%) recommended that their athletes practice gradual weight loss methods using a combination of dehydration or increased physical activity (80.3%), sweat suits (50.8%), restricted fluid intake (39.3%), training in heated rooms (27%), and sauna (26.2%). Recommendations of spitting (27.8%) or using laxatives, diuretics, diet pills, or vomiting (21.3%) were also reported. Coaches and trainers often encouraged athletes to cut weight before competition. The methods recommended are potentially harmful with severe health risks, including compromised nutritional status and diminished athletic performance. This is of particular concern in young athletes who are still growing and developing physically. Enhancing knowledge and awareness for coaches, athletes, and parents regarding potential dangers, along with improved nutrition education, is critical for reducing the magnitude and misuse of rapid weight loss methods.

Consumption of soy-based infant formula is not associated with early onset of puberty.

PURPOSE: The use of soy products is common in young children with cow milk allergy (CMA). The aim was to examine prospectively the association between infantile consumption of soy-based formula, growth parameters and early pubertal signs, in comparison to cow milk-based formula. METHODS: A nested case-control study was conducted, selected from a cohort of infants prospectively followed from birth until the age of 3 years for eating habits and the development of IgE-mediated CMA. Infants who consumed only soy-based formula were included in the soy group. The control group was randomly selected from those without IgE-CMA and not receiving soy formula. Study participants were reevaluated between ages 7.8 and 10.5 years by an interview, nutritional intake by 3 days diaries, and height, weight, and pubertal signs by physical examination. RESULTS: The soy-fed group included 29 participants (17 males), median age 8.92 years IQR (8.21, 9.42). The control group included 60 participants (27 males), median age 8.99 years IQR (8.35, 9.42). The groups had comparable height and BMI z scores (- 0.17 ± 1.08 versus - 0.16 ± 1.01, p = 0.96, and 0.67 ± 1.01 versus 0.53 ± 1.02, p = 0.56, for soy and control groups, respectively). Four (three males and one female) from the soy-group (13.8%) and eight females from the control-group (13.3%) had early pubertal signs (p = 0.95). No association was detected between puberty and infantile nutrition, after controlling for BMI and family data. No association with puberty or differences between groups were found in current daily consumption of soy, micronutrients, energy, carbohydrates, fat, and protein. CONCLUSIONS: This is the first prospective, physical examination-based study, demonstrating no association between infantile soy-based formula consumption and growth and puberty parameters.

Reduced Final Height and Inadequate Nutritional Intake in Cow's Milk-Allergic Young Adults.

BACKGROUND: Growth impairment was previously described in milk-allergic children but was not examined in adults on reaching final height. OBJECTIVES: To investigate the dietary intake and final stature of young adults with IgE-mediated cow's milk allergy (IgE-CMA) as compared with nonallergic controls. METHODS: Eighty-seven patients with IgE-CMA, median age 19.5 years (interquartile range [IQR], 17.3-22.7), and 36 control participants without food allergies, median age 22.7 years (IQR, 18.9-26.1), were studied. Anthropometric and nutritional data were collected. Age and gender z-scores were determined according to the Centers for Disease Control and Prevention growth charts. Nutrient intake assessment was based on dietary records. Individuals with conditions or treatments affecting bone metabolism or growth, other than asthma, were excluded. RESULTS: Mean values of height z-scores were significantly reduced in CMA subjects compared with controls (-0.64 ± 0.9 vs -0.04 ± 0.7, P = .001). In contrast, no differences were found between the 2 groups in weight and body mass index z-scores. Patients with CMA had significantly lower intake of protein, and several essential vitamins (A, B12, and riboflavin) and minerals (calcium, potassium, phosphorus, magnesium, and zinc) compared with controls (P < .05), but the intakes of calories, carbohydrate, and fat were not significantly different between the 2 groups. Differences between actual and expected (based on midparental height) height z-scores were comparable in CMA subjects with or without asthma and between those with and without additional food allergies. CONCLUSIONS: Young adults who have CMA from infancy are at risk of not reaching their growth potential. Growth and nutritional monitoring and appropriate dietary intervention are of particular importance in these at-risk individuals.