The eNutrition Academy: Supporting a New Generation of Nutritional Scientists around the World.

Nutrition training and building capacity to provide a competent workforce to support national and regional efforts to combat malnutrition remain a major challenge in Africa and other developing regions of the world. The capacity to provide the necessary intellectual drive for nutrition research, policy, and practice in countries lacking in readiness for nutrition actions is imperative to improve the health of their people. To help address this need, the eNutrition Academy (eNA) was formed as a global partnership organization by the African Nutrition Society, the Federation of African Nutrition Societies, the Nutrition Society of the United Kingdom and Ireland, the ASN, and the International Union of Nutritional Sciences, supported by Cambridge University Press. The primary objective of this partnership is to provide an online learning platform that is free to access, enabling users to benefit from a wide range of learning materials from basic tools to more-advanced learning materials for teachers and researchers in developing countries. The goal of this article was to summarize the findings of a symposium held at the ASN Scientific Sessions and Annual Meeting at Experimental Biology 2015, which explored the themes of international capacity development, with a particular focus on the African continent, online learning, and the eNA e-learning platform. Given the vast human capacity present in Africa that is poised to create new solutions to address the public health needs of the continent, now is an opportune time to establish South-North and South-South partnerships to develop the next generation of African nutritional scientists.

Capacity building in public health nutrition.

The aim of the present paper is to review capacity building in public health nutrition (PHN), the need for which has been stressed for many years by a range of academics, national and international organisations. Although great strides have been made worldwide in the science of nutrition, there remain many problems of undernutrition and increasingly of obesity and related chronic diseases. The main emphasis in capacity building has been on the nutrition and health workforce, but the causes of these health problems are multifactorial and require collaboration across sectors in their solution. This means that PHN capacity building has to go beyond basic nutrition and beyond the immediate health workforce to policy makers in other sectors. The present paper provides examples of capacity building activities by various organisations, including universities, industry and international agencies. Examples of web-based courses are given including an introduction to the e-Nutrition Academy. The scope is international but with a special focus on Africa. In conclusion, there remains a great need for capacity building in PHN but the advent of the internet has revolutionised the possibilities.

Iron, meat and health.

This article is a summary of the publication "Iron and Health" by the Scientific Advisory Committee on Nutrition (SACN) to the U.K. Government (2010), which reviews the dietary intake of iron and the impact of different dietary patterns on the nutritional and health status of the U.K. population. It concludes that several uncertainties make it difficult to determine dose-response relationships or to confidently characterize the risks associated with iron deficiency or excess. The publication makes several recommendations concerning iron intakes from food, including meat, and from supplements, as well as recommendations for further research.

Post-prandial iron absorption in humans: comparison between HFE genotypes and iron deficiency anaemia.

BACKGROUND & AIMS: Measurement of serum iron increase after ingestion of a meal could be an efficient method of comparing post-prandial iron absorption between groups of individuals. We determined whether the rise in post-prandial serum iron is increased in fully treated patients with hereditary haemochromatosis (HFE C282Y+/+; HH) compared to iron deficiency anaemia (IDA), iron-replete heterozygous subjects (HFE C282Y+/-) and iron-replete controls (HFE C282Y-/-). METHODS: Serum iron increase was measured over 4h after a meal containing 13.1 mg non-haem iron. RESULTS: Post-prandial increase in serum iron was similar in treated HH versus IDA (P=0.54), but greater than control subjects (P<0.0001). In five HH patients, using (58)Fe as a tracer, the rate of iron absorption was increased (P<0.05) and serum non-transferrin bound iron showed a tendency to increase (P=0.06). Serum iron curves did not differ for heterozygous subjects and controls (P=0.65). CONCLUSIONS: Using the serum iron method we found a comparable increase in post-prandial iron absorption in treated HH and IDA compared with controls. While post-prandial iron absorption in the group heterozygous for the C282Y mutation was modestly increased relative to controls, this difference was not statistically significant.

Risk factors for cardiovascular disease in patients with anorexia nervosa.

BACKGROUND: hypercholesterolemia, hypercortisolemia and low levels of essential fatty acids, oestrogens and antioxidant vitamins are more prevalent in patients with anorexia nervosa (AN) than in the general population. OBJECTIVE: This study aims (1) to compare cardiovascular risk parameters in-patients with AN and controls, and (2) to compare the parameters in-patients on admission and at four month follow up. METHODS: Blood samples and anthropometry were taken from patients with AN on admission (N=30) and matched controls (N=30). Twenty one patients were re-tested after four months of treatment. RESULTS: Total cholesterol, LDL, Apo B and fibrinogen concentrations were elevated in patients on admission compared with controls, while retinol and tocopherol were decreased. Low levels of T3, T4 and estradiol were correlated with increased cholesterol values. After treatment there was a tendency for most of the abnormal markers to normalise. However, HDL levels decreased leaving patients with an undesirable lipid profile. CONCLUSIONS: Cardiovascular disease is not commonly a problem in these patients, however, with age, and without treatment, the cardiovascular risk may increase.

A food-group based algorithm to predict non-heme iron absorption.

OBJECTIVE: To develop an algorithm to predict the percentage non-heme iron absorption based on the foods contained in a meal (wholemeal cereal, tea, cheese, etc.). Existing algorithms use food constituents (phytate, polyphenols, calcium, etc.), which can be difficult to obtain. DESIGN: A meta-analysis of published studies using erythrocyte incorporation of radio-isotopic iron to measure non-heme iron absorption. METHODS: A database was compiled and foods were categorized into food groups likely to modify non-heme iron absorption. Absorption data were then adjusted to a common iron status and a weighted multiple regression was performed. RESULTS: Data from 53 research papers (3,942 individual meals) were used to produce an algorithm to predict non-heme iron absorption (R(2) =0.22, P < 0.0001). CONCLUSIONS: The percentage non-heme iron absorption can be predicted from information on the types of foods contained in a meal with similar efficacy to that of food-constituent-based algorithms (R(2) = 0.16, P= 0.0001).

Proton pump inhibitors suppress absorption of dietary non-haem iron in hereditary haemochromatosis.

BACKGROUND AND AIMS: During the long-term treatment of patients with hereditary haemochromatosis (HH) the authors observed that proton pump inhibitors (PPI) reduced the requirement for maintenance phlebotomy. Gastric acid plays a crucial role in non-haem iron absorption and the authors performed a case review and intervention study to investigate if PPI-induced suppression of gastric acid would reduce dietary iron absorption in C282Y homozygous patients. METHODS: Phlebotomy requirements to keep serum ferritin approximately 50 microg/l before (mean 6.1 (SE 0.6) years) and during (3.8 (0.9) years) administration of a PPI were evaluated in seven patients and a post-prandial study was performed to determine whether PPIs reduce absorption of non-haem iron (14.5 mg) from a test meal in a further 14 phlebotomised patients with normal iron stores. RESULTS: There was a significant reduction (p<0.001) in the volume of blood removed annually before (2.5 (0.25) l) and while taking (0.5 (0.25) l) a PPI. Administration of a PPI for 7d suppressed absorption of non-haem iron from the meal as shown by a significant reduction (all p<0.01) in: area under the serum curve (2145 (374) versus 1059 (219)), % recovery of administered iron at peak serum iron (20.5 (3.2) versus 11.0 (2.0)%) and peak serum iron (13.6 (2.4) vs 6.1 (1.2) micromol/l) (all values are before vs during PPI). CONCLUSIONS: Administration of a PPI to patients with HH can inhibit the absorption of non-haem iron from a test meal and the habitual diet.

Iron bioavailability: UK Food Standards Agency workshop report.

The UK Food Standards Agency convened a group of expert scientists to review current research investigating factors affecting iron status and the bioavailability of dietary iron. Results presented at the workshop show menstrual blood loss to be the major determinant of body iron stores in premenopausal women. In the presence of abundant and varied food supplies, the health consequences of lower iron bioavailability are unclear and require further investigation.

Serum iron curves can be used to estimate dietary iron bioavailability in humans.

Erythrocyte incorporation of isotopic iron (Fe) is the standard method for assessing iron bioavailability, but the process is expensive, technically difficult, and gives no information on the kinetics of absorption. The main objective of this study was to validate serum Fe curves as measures of dietary iron absorption because previous work demonstrated that serum iron curves can be generated with iron doses as low as 5-20 mg and that up to 20 mg iron can be added to meals without affecting relative absorption. In 3 studies, groups (n = 10, 10, 21) of Fe-deficient, mildly anemic women consumed meals of varying calculated Fe bioavailability, with and without added ferric chloride (10 mg Fe). Blood samples were collected at baseline and every 30 min for 4 h after the meal. Serum Fe concentrations were measured. Areas under the serum Fe curves and peak concentrations were used in different models to estimate Fe absorption and uptake. In 21 subjects, (58)Fe-enriched ferric chloride was added to the meals, and blood was taken 2 wk later to calculate red cell isotope incorporation. The addition of 10 mg Fe to test meals produced measurable serum iron curves even when the meal Fe bioavailability was low. Serum Fe curves were highly reproducible and were affected as expected by food composition. Even the single measurement at the estimated time of peak iron concentration was correlated significantly with erythrocyte incorporation of (58)Fe (r = 0.72, P < 0.0001). Hence the extent and rate of absorption of nonheme iron from meals, rather than in individuals, can be investigated with such subjects without the need for isotopes.

Cholesterol concentrations in patients with Anorexia Nervosa and in healthy controls.

UNLABELLED: Argentinean women have one of the highest international mortality rates for cardiovascular disease and they are particularly vulnerable to eating pathologies. Cardiovascular risk is exacerbated in women with Anorexia Nervosa (AN), since high cholesterol concentrations have been widely reported. OBJECTIVES: To compare blood cholesterol concentrations in AN patients with controls, and to correlate cholesterol with the body mass index (BMI), patient age, vomiting and tobacco. DESIGN AND METHOD: Cholesterol measurements documented at diagnosis from the clinical notes of patients were recorded from the Association Against Bulimia and Anorexia (ALUBA). Comparison was carried out with data of the general Argentinean public. RESULTS: Total cholesterol, LDL and HDL concentrations were higher in patients compared with controls. Total cholesterol in patients decreased during treatment and it was correlated with the patient age, but with no other variable. CONCLUSION: The abnormal lipid profile places patients at risk for cardiovascular disease. Older and untreated patients may be at particular higher risk of suffering from the consequences of elevated cholesterol concentrations.

Tratamiento de la anorexia nerviosa: riesgo cardiovascular y de osteoporosis / Anorexia nervosa tratment: cardiovascular and osteoporosis risk

Introducción: Los pacientes con Anorexia Nerviosa (AN) presentan factores de riesgo de enfermedades cardiovasculares y osteoporosis (hipercolesterolemia, hipercortisolemia, bajos niveles de antioxidantes y de ácidos grasos escenciales, el uso de tabaco y cafeína, la baja ingesta de calcio, amenorrea, bajo peso corporal, ejercicio extenuante y vegetarianismo) raramente son considerados en el curso del tratamiento nutricional. Objetivo: Investigar si en el tratamiento de la AN se tiene en cuenta el riesgo cardiovascular y de osteoporosis. Metodología: Instituciones privadas y estatales de la Ciudad de Buenos Aires, Argentina, que ofrecen tratamiento para la AN, respondieron un cuestionario a cerca de la terapéutica frente al riesgo cardiovascular y la osteoporosis. Resultados: La hipercolesterolemia y la pérdida de masa ósea fueron identificadas como frecuentes en menos de la mitad de los pacientes. El 61 por ciento de las institucionaes prescribía una alimentación rica en grasa para la recuperación veloz del peso y el 53 por ciento de los servicios señaló que el sobrepeso es un problema luego de la re-alimentación. La tolerancia de comportamientos de riesgo que contribuyen a las enfermedades cardiovasculares, osteoporosis y al mantenimiento de los trastornos de la conducta alimentaria como el uso de tabaco, sal, café, vegetarianismo, productos dietéticos, fué tomada como una decisión arbitraria por parte de dichas instituciones. Conclusión: La mayoría de las instituciones no contemplan los factores de riesgo cardiovascular y de osteoporosis que los pacientes son vulnerables de padecer. También se carece de estudios y normas para el cuidado nutricional de los pacientes con AN

Tratamiento de la anorexia nerviosa: riesgo cardiovascular y de osteoporosis / Anorexia nervosa tratment: cardiovascular and osteoporosis risk

Introducción: Los pacientes con Anorexia Nerviosa (AN) presentan factores de riesgo de enfermedades cardiovasculares y osteoporosis (hipercolesterolemia, hipercortisolemia, bajos niveles de antioxidantes y de ácidos grasos escenciales, el uso de tabaco y cafeína, la baja ingesta de calcio, amenorrea, bajo peso corporal, ejercicio extenuante y vegetarianismo) raramente son considerados en el curso del tratamiento nutricional. Objetivo: Investigar si en el tratamiento de la AN se tiene en cuenta el riesgo cardiovascular y de osteoporosis. Metodología: Instituciones privadas y estatales de la Ciudad de Buenos Aires, Argentina, que ofrecen tratamiento para la AN, respondieron un cuestionario a cerca de la terapéutica frente al riesgo cardiovascular y la osteoporosis. Resultados: La hipercolesterolemia y la pérdida de masa ósea fueron identificadas como frecuentes en menos de la mitad de los pacientes. El 61 por ciento de las institucionaes prescribía una alimentación rica en grasa para la recuperación veloz del peso y el 53 por ciento de los servicios señaló que el sobrepeso es un problema luego de la re-alimentación. La tolerancia de comportamientos de riesgo que contribuyen a las enfermedades cardiovasculares, osteoporosis y al mantenimiento de los trastornos de la conducta alimentaria como el uso de tabaco, sal, café, vegetarianismo, productos dietéticos, fué tomada como una decisión arbitraria por parte de dichas instituciones. Conclusión: La mayoría de las instituciones no contemplan los factores de riesgo cardiovascular y de osteoporosis que los pacientes son vulnerables de padecer. También se carece de estudios y normas para el cuidado nutricional de los pacientes con AN (AU)