Evaluating instrumental learning and striatal-cortical functional connectivity in adolescent alcohol and cannabis use.

Adolescence is a vulnerable time for the acquisition of substance use disorders, potentially relating to ongoing development of neural circuits supporting instrumental learning. Striatal-cortical circuits undergo dynamic changes during instrumental learning and are implicated in contemporary addiction theory. Human studies have not yet investigated these dynamic changes in relation to adolescent substance use. Here, functional magnetic resonance imaging was used while 135 adolescents without (AUD-CUDLow ) and with significant alcohol (AUDHigh ) or cannabis use disorder symptoms (CUDHigh ) performed an instrumental learning task. We assessed how cumulative experience with instrumental cues altered cue selection preferences and functional connectivity strength between reward-sensitive striatal and cortical regions. Adolescents in AUDHigh and CUDHigh groups were slower in learning to select optimal instrumental cues relative to AUD-CUDLow adolescents. The relatively fast learning observed for AUD-CUDLow adolescents coincided with stronger functional connectivity between striatal and frontoparietal regions during early relative to later periods of task experience, whereas the slower learning for the CUDHigh group coincided with the opposite pattern. The AUDHigh group not only exhibited slower learning but also produced more instrumental choice errors relative to AUD-CUDLow adolescents. For the AUDHigh group, Bayesian analyses evidenced moderate support for no experience-related changes in striatal-frontoparietal connectivity strength during the task. Findings suggest that adolescent cannabis use is related to slowed instrumental learning and delays in peak functional connectivity strength between the striatal-frontoparietal regions that support this learning, whereas adolescent alcohol use may be more closely linked to broader impairments in instrumental learning and a general depression of the neural circuits supporting it.

Role of Food Industry in Promoting Healthy and Sustainable Diets.

Sustainable food systems are often defined by greenhouse gases, land use, effects on biodiversity, and water use. However, this approach does not recognize the reason food is produced-the provision of nutrients. Recently, the relationship between diets and sustainability has been recognized. Most accepted models of 'sustainable diets' focus on four domains: public health, the environment, food affordability, and cultural relevance. Aligned with the FAO's perspective, truly sustainable diets comprise foods that are affordable, nutritious, developed with ingredients produced in an environmentally friendly manner, and consumer preferred. Identifying solutions to address all four domains simultaneously remains a challenge. Furthermore, the recent pandemic exposed the fragility of the food supply when food accessibility and affordability became primary concerns. There have been increasing calls for more nutrient-dense and sustainable foods, but scant recognition of the consumer's role in adopting and integrating these foods into their diet. Dietary recommendations promoting sustainable themes often overlook how and why people eat what they do. Taste, cost, and health motivate consumer food purchase and the food system must address those considerations. Sustainable foods are perceived to be expensive, thus marginalizing acceptance by the people, which is needed for broad adoption into diets for impactful change. Transformational change is needed in food systems and supply chains to address the complex issues related to sustainability, taste, and cost. An emerging movement called regenerative agriculture (a holistic, nature-based approach to farming) provides a pathway to delivering sustainable foods at an affordable cost to consumers. A broad coalition among academia, government, and the food industry can help to ensure that the food supply concurrently prioritizes sustainability and nutrient density in the framework of consumer-preferred foods. The coalition can also help to ensure sustainable diets are broadly adopted by consumers. This commentary will focus on the challenges and opportunities for the food industry and partners to deliver a sustainable supply of nutrient-dense foods while meeting consumer expectations.

Consensus, Global Definitions of Whole Grain as a Food Ingredient and of Whole-Grain Foods Presented on Behalf of the Whole Grain Initiative.

Proposed global definitions of whole grain as an ingredient and whole grain food are presented by the authors on behalf of the Whole Grain Initiative. Whole grains are an important pillar of healthy and sustainable diets. Internationally accepted credible definitions of whole grains as food ingredients and whole-grain foods are necessary to ensure that all global stakeholders have shared standards, and that consumers find them clear, credible, and useful. Based on widely accepted, existing definitions and new developments, the Definitions Working Group of the global Whole Grain Initiative, with experts from academia, government agencies and industry, developed definitions for global application. The key statements of the definition documents are as follows: "Whole grains shall consist of the intact, ground, cracked, flaked or otherwise processed kernel after the removal of inedible parts such as the hull and husk; all anatomical components, including the endosperm, germ, and bran must be present in the same relative proportions as in the intact kernel" and "A whole-grain food shall contain at least 50% whole-grain ingredients based on dry weight. Foods containing 25-50% whole-grain ingredients based on dry weight, may make a front-of-pack claim on the presence of whole grain but cannot be designated 'whole grain' in the product name". The definition documents have been ratified by the leading international scientific associations in this area. We urge that these consensus Whole Grain Initiative definitions be adopted as the basis for definitions used by national regulatory authorities and for health promotion organisations worldwide to use in nutrition education and food labelling.

Evidence mapping to assess the available research on fiber, whole grains, and health.

Evidence mapping is a useful methodology for characterizing existing research on a broad topic and identifying gaps in the scientific literature. Evidence mapping entails conducting a systematic literature search and extracting information on study details, often in the form of a database. Researchers at Tufts University and the North American branch of the International Life Sciences Institute created the Diet-Related Fibers & Human Health Outcomes Database, which is publicly available and updated annually. The database captures intervention studies examining dietary fiber and 10 predefined physiological health outcomes, including weight/adiposity, blood pressure, gut microbiota, and bone health. The database and subsequent potential for evidence mapping may be particularly useful in light of new food labeling requirements by the US Food and Drug Administration that require fibers to have accepted scientific evidence of a physiological health benefit in order to be labeled as "dietary fiber." Following the success of the fiber database, Tufts University and the General Mills Bell Institute of Health and Nutrition collaborated to develop a whole grain database and evidence map. This work successfully highlighted the need for better consistency in how whole grains are reported with respect to amount and type of whole grains and intervention compliance.

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Destigmatizing Carbohydrate with Food Labeling: The Use of Non-Mandatory Labelling to Highlight Quality Carbohydrate Foods.

Dietary carbohydrates are components of healthy foods, but many carbohydrate foods have recently been stigmatized as primary causes of diet-related risk factors for chronic disease. There is an opportunity to enhance efforts within the food landscape to encourage the consumption of higher quality carbohydrate foods. The use of labelling is one strategy that permits consumers to identify healthy carbohydrate foods at the point-of-purchase. This review discusses the regulatory frameworks and examples of associated non-mandatory food labelling claims that are currently employed to highlight healthy carbohydrate foods to consumers. The existing labelling frameworks discussed here align with established measures of carbohydrate quality, such as 1. dietary fibre nutrient content claims and associated dietary fibre-based health claims; 2. the presence of whole carbohydrate foods and ingredients that are intact or reconstituted, such as whole grains; and 3. low glycemic index and glycemic response claims. Standards from Codex Alimentarius, and regulations from Australia and New Zealand, Canada, Europe, and the United States will be used to illustrate the means by which food labelling can be used by consumers to identify quality carbohydrate foods.

Amniotic Fluid Embolism: Using the Medical Staff Process to Facilitate Streamlined Care.

Amniotic fluid embolism (AFE) is a catastrophic consequence of labor and delivery that often results in maternal and neonatal death. These poor outcomes are related largely to the rarity of the event in a population overwhelmingly biased by overall good health. Despite the presence of national AFE registries, there are no published algorithmic approaches to its management, to our knowledge. The purpose of this article is to share a care pathway developed by a multidisciplinary group at a community teaching hospital. Post hoc analysis of a complicated case of AFE resulted in development of this pathway, which addresses many of the major consequences of AFE. We offer this algorithm as a template for use by any institution willing to implement a clinical pathway to treat AFE. It is accompanied by the remarkable case outcome that prompted its development.

Fortification and health: challenges and opportunities.

Fortification is the process of adding nutrients or non-nutrient bioactive components to edible products (e.g., food, food constituents, or supplements). Fortification can be used to correct or prevent widespread nutrient intake shortfalls and associated deficiencies, to balance the total nutrient profile of a diet, to restore nutrients lost in processing, or to appeal to consumers looking to supplement their diet. Food fortification could be considered as a public health strategy to enhance nutrient intakes of a population. Over the past century, fortification has been effective at reducing the risk of nutrient deficiency diseases such as beriberi, goiter, pellagra, and rickets. However, the world today is very different from when fortification emerged in the 1920s. Although early fortification programs were designed to eliminate deficiency diseases, current fortification programs are based on low dietary intakes rather than a diagnosable condition. Moving forward, we must be diligent in our approach to achieving effective and responsible fortification practices and policies, including responsible marketing of fortified products. Fortification must be applied prudently, its effects monitored diligently, and the public informed effectively about its benefits through consumer education efforts. Clear lines of authority for establishing fortification guidelines should be developed and should take into account changing population demographics, changes in the food supply, and advances in technology. This article is a summary of a symposium presented at the ASN Scientific Sessions and Annual Meeting at Experimental Biology 2014 on current issues involving fortification focusing primarily on the United States and Canada and recommendations for the development of responsible fortification practices to ensure their safety and effectiveness.

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.

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.

Surgical repair of pulmonary artery sling in an adult.

Pulmonary artery sling is a rare congenital vascular anomaly that typically presents in the first month of life with severe respiratory symptoms. In this condition, the left pulmonary artery originates off the right pulmonary artery and courses between the trachea and esophagus, causing compression of both structures. Of those patients with pulmonary artery sling, a small subset survives to adulthood with few or no symptoms. In this article we present the surgical correction of pulmonary artery sling in an adult patient.

Optimal protein intake in the elderly.

The recommended dietary allowance (RDA) for protein, as promulgated by the Food and Nutrition Board of the United States National Academy of Science, is 0.8 g protein/kg body weight/day for adults, regardless of age. This value represents the minimum amount of protein required to avoid progressive loss of lean body mass in most individuals. There is an evidence that the RDA for elderly may be greater than 0.8 g/kg/day. Evidence indicates that protein intake greater than the RDA can improve muscle mass, strength and function in elderly. In addition, other factors, including immune status, wound healing, blood pressure and bone health may be improved by increasing protein intake above the RDA. Furthermore, the RDA does not address the recommended intake of protein in the context of a balanced diet. Concerns about potential detrimental effects of increased protein intake on bone health, renal function, neurological function and cardiovascular function are generally unfounded. In fact, many of these factors are improved in elderly ingesting elevated quantities of protein. It appears that an intake of 1.5 g protein/kg/day, or about 15-20% of total caloric intake, is a reasonable target for elderly individuals wishing to optimize protein intake in terms of health and function.

A comparison of treatment impacts between Invisalign aligner and fixed appliance therapy during the first week of treatment.

INTRODUCTION: The aim of this study was to evaluate the differences in quality of life impacts between subjects treated with Invisalign aligners (Align Technology, Santa Clara, Calif) and those with fixed appliances during the first week of orthodontic treatment. METHODS: A prospective, longitudinal cohort study involving 60 adult orthodontic patients (33 with Invisalign aligners, 27 with fixed appliances) was completed by using a daily diary to measure treatment impacts including functional, psychosocial, and pain-related outcomes. A baseline survey was completed before the start of treatment; diary entries were made for 7 consecutive days to measure various impacts of the subjects' orthodontic treatment over time. The data were then analyzed for differences between treatment modalities in terms of the subjects' reported impacts from their orthodontic treatment. RESULTS: The baseline mean values did not differ between groups for pain reports (P = .22) or overall quality of life impact (P = .51). During the first week of treatment, the subjects in the Invisalign group reported fewer negative impacts on overall quality of life (P <.0001). The Invisalign group also recorded less impact in each quality of life subscale evaluated (functional, psychosocial, and pain-related, all P <.003). The visual analog scale pain reports showed that subjects in the Invisalign group experienced less pain during the first week of treatment (P <.0001). The subjects in the fixed appliance group took more pain medications than those in the Invisalign group at days 2 and 3 (both P <.007). CONCLUSIONS: Adults treated with Invisalign aligners experienced less pain and fewer negative impacts on their lives during the first week of orthodontic treatment than did those treated with fixed appliances.

Manganese depresses rat heart muscle respiration.

It has previously been reported that moderately high dietary manganese (Mn) in combination with marginal magnesium (Mg) resulted in ultrastructural damage to heart mitochondria. Manganese may replace Mg in biological functions, including the role of enzyme cofactor. Manganese may accumulate and substitute for Mg during the condition of Mg-deficiency. The objective of the current study was to determine whether high Mn alters heart muscle respiration and Mg-enzyme activity as well as whole body Mn retention under marginal Mg. An additional objective was to determine whether high Mn results in increased oxidative stress. In experiment 1: forty-eight rats were fed a 2 x 3 factorial arrangement of Mn (10, 100, or 1000 mg/kg) and Mg (200 or 500 mg/kg). In experiment 2: thirty-two rats were fed one of four diets in a 2 x 2 factorial arrangement of Mn (10 or 250 mg/kg) and Mg (200 or 500 mg/kg). In experiment 3: thirty-two rats were fed one of four diets in a 2 x 2 factorial arrangement of Mn (10 or 650 mg/kg) and Mg (200 or 500 mg/kg). In experiment 2, high Mn and marginal Mg reduced (P<0.05) oxygen consumption of left ventricle muscle. Marginal Mg, but not Mn, reduced (P<0.05) activity of sarcoplasmic reticulum calcium-ATPase enzyme. Dietary Mg had no affect on (54)Mn kinetics, but high dietary Mn decreased (P<0.01) absorption, retention, and rate of excretion of (54)Mn. Neither cellular stress, measured by Comet assay, nor antioxidant activities were increased by high Mn. A strong interaction (P<0.001) between increasing Mn and adequate Mg on hematology was observed. These results confirm previous research in swine that high Mn alters myocardial integrity as well as function, but not as a result of altered calcium transport or oxidative stress.

Manganese alters mitochodrial integrity in the hearts of swine marginally deficient in magnesium.

It was previously reported that pigs marginally deficient in magnesium (Mg) and fed diets high in manganese (Mn) died suddenly with signs of sudden cardiac death. Manganese, which has properties similar to Mg, may exacerbate Mg-deficiency and be accumulated by mitochondria resulting in ultrastructural damage. The objective of this study was to determine whether deaths of the type previously observed were mediated by adverse interactions of Mn and Mg resulting in ultrastructural damage to the myocardium, alterations in electrocardiographic recordings and tissue retention of Mn, Mg and calcium (Ca). Forty-eight pigs were fed one of six diets in a 2 X 3 factorial arrangement of Mg (100 or 1000 mg Mg/kg) and Mn (5, 50 or 500 mg Mn/kg) for 8 weeks. Left ventricle muscle samples were collected for examination by transmission electron microscopy. No differences in heart muscle ultrastructure were observed between pigs fed low and adequate dietary Mg. However, marked myocardial necrosis and mitochondrial swelling were observed in pigs fed high dietary Mn when combined with low Mg. Feeding low dietary Mg elevated minimum (P < 0.01), maximum (P < 0.05) and average (P < 0.001) heart rates. Low dietary Mg resulted in a 55% probability of a ventricular beat being recorded (P = 0.05) and lower Mg (P < 0.02) and Ca (P < 0.04) contents in heart atria and ventricles. These results suggest that high Mn, when fed in combination with low Mg, disrupts mitochondrial ultrastructure and is associated with the sudden deaths previously reported.