Nutritional Characteristics of Menus in State Prisons.

Nutrition-related health disparities plague prisons in the United States. Unregulated and inadequate prison menus may contribute to noncommunicable chronic health conditions in this vulnerable population. The purpose of this research was to assess nutrition offerings provided by prison menus. Researchers requested the most current version of all master menus and associated nutrition analyses for gendered and age-centric (pediatric vs geriatric) menus. Menu and nutrient data were extracted and entered into a spreadsheet for analysis. Prisons serve gendered or nongendered menus to the general population, and 52.9% of prisons offer nongendered menus where males and females receive the same meals. This approach provides excess calories and saturated fat to females. Sodium was served in excess to both males and females. Fruit and vegetable servings on all gendered menus fell short of recommendations. The average prison menu inappropriately offers calories, sodium, and fruit and vegetable servings in a one-size-fits-all menu development method without considering gender, age, and physical activity. Interpretation and application of Dietary Guidelines for Americans are inconsistent. Nutrition guidelines recommending appropriate nutrients and food groups should be developed and available to corrections systems and dietitians. Current prison menu development practices yield inappropriate nutrition for prison populations.

Construct validity of the Charitable Food Nutrition Index.

Background: Food pantries are an important source of food for those facing food insecurity. The Charitable Food Nutrition Index (CFNI) was developed for research and practice to measure the nutritional quality of assortments of foods in this setting. Objective: The study assessed the construct validity of the CFNI using secondary data from a group-randomized food pantry intervention in Minnesota. Methods: The CFNI was calculated for each client cart post-intervention (n = 187; 85 intervention, 102 control). CFNI scores were based on the proportion of items in each client cart ranked "green," "yellow," or "red" using the Healthy Eating Research Nutrition Guidelines for the Charitable Food System. An implementation score assessing intervention fidelity was measured for each pantry (n = 11; 5 intervention, 6 control) based on the four intervention subcomponents: aesthetics/use of space; healthy food prominence and appeal; unhealthy food de-emphasis; and stocking standards. Mixed linear models were used to test whether: (a) client carts from pantries in the intervention condition had higher CFNI scores than those in the control condition, and (b) higher implementation scores were associated with higher CFNI scores. Results: In adjusted models, clients from intervention group pantries had higher CFNI scores, reflecting a healthier assortment of foods compared with clients from control group pantries (p = 0.022). CFNI scores were positively associated with greater fidelity to the intervention (p = 0.020). Conclusions: The CFNI was sensitive enough to detect the effects of the intervention in the expected directions. These findings support its construct validity and utility as a measure in the charitable food system.

Optimizing Nutritional Status of Patients Prior to Major Surgical Intervention.

In patients undergoing elective cardiovascular and thoracic surgery, malnutrition and the deterioration of nutritional status are associated with negative outcomes. Recognition of the contributory factors and the complications stemming from surgical stress is important for the prevention and management of these patients. We have reviewed the literature available and focused on the nutritional and metabolic aspects affecting surgical patients, with emphasis on the recommendations of enhanced recovery protocols. The implementation of enhanced recovery protocols and nutritional support guidelines focusing on the surgical patient as part of a multidisciplinary approach would improve the nutritional status of surgical patients at risk for negative outcomes.

Infant burn injuries related to water heating for powdered infant formula preparation.

Background: Guidance for preparing powdered infant formula (PIF) helps to ensure it meets the nutritional needs of infants and is safe to consume. Among safety concerns is Cronobacter sakazakii contamination which can lead to serious infections and death. PIF preparation guidance varies; there is a lack of consensus on whether there is a need to boil water to inactivate potential Cronobacter and for how long to let the water cool before reconstitution. We sought to quantify the burden of burn injuries among infants related to water heating for PIF preparation. Estimating this burden may help inform preparation recommendations. Methods: Burn injuries among infants <18 months of age were identified from 2017 to 2019 National Electronic Injury Surveillance System data collected from sampled hospital emergency departments. Injuries were classified as related to PIF water heating, potentially related to PIF water heating but with undetermined causation, related to other infant feeding aspects, or unrelated to infant formula or breast milk feeding. Unweighted case counts for each injury classification were determined. Results: Across sampled emergency departments, 7 PIF water heating injuries were seen among the 44,395 injuries reported for infants <18 months. No reported PIF water heating injuries were fatal, but 3 required hospitalization. Another 238 injuries potentially related to PIF water heating but with undetermined causation were also seen. Conclusion: Preparation guidance should consider both the potential risk for Cronobacter infection and the potential risk for burns.

Supermarket promotions in Western Sweden are incompatible with Nordic dietary recommendations and differ by area-level socioeconomic index.

BACKGROUND: Large supermarket chains produce weekly advertisements to promote foods and influence consumer purchases. The broad consumer reach of these ads presents an opportunity to promote foods that align with dietary recommendations. Thus, the aim of this study was to investigate the health quality of supermarkets' weekly food promotions in a large region of Sweden with attention to more and less advantaged socioeconomic index areas. METHODS: Analysis of weekly advertisements from 122 individual stores, representing seven chains, was carried out in a large region of Sweden from 2-29 March in 2020. Food promotions were divided into categories according to the Nordic Nutrition Recommendations and World Health Organization Regional Office for Europe's nutrient profile model, and defined as 'most healthy', 'healthy', 'unhealthy' and 'most unhealthy'. A mean socioeconomic index was used to classify each store location to determine whether proportions of the 'most unhealthy' foods differed between more advantaged and more disadvantaged socioeconomic index areas. RESULTS: In total, 29,958 food items were analyzed. Two-thirds of promotions belonged to the food groups considered 'most unhealthy' and 'unhealthy'. In the 'most unhealthy' food group 'sugar-rich beverages and foods' constituted approximately 23.0% of the promotions. Food promotions had 25% increased odds to be from the 'most unhealthy' group (odds ratio 1.25, confidence interval 1.17, 1.33) in more disadvantaged socioeconomic index areas. This association could be explained by the supermarket chain the stores belonged to. CONCLUSIONS: Our findings indicate that Swedish supermarkets promote a large proportion of unhealthy foods as classified by the Nordic Nutrition Recommendations. We also observe that certain national supermarket chains tend to locate their stores in more disadvantaged areas and promote a greater proportion of unhealthy foods in their weekly advertisements compared to the more advantaged areas. There is an urgent need for supermarkets to shift promotions toward healthier food items.

Evaluation of US Department of Agriculture Foods Programs for Households Using Nutrition Guidelines for the Charitable Food System.

BACKGROUND: US Department of Agriculture (USDA) Foods programs for households (ie, The Emergency Food Assistance Program, Food Distribution Program on Indian Reservations, and Commodity Supplemental Food Program) are designed to provide nutritious foods at no cost to income-eligible individuals in the United States. OBJECTIVE: Our aim was to evaluate the nutritional quality of the foods available from 3 USDA Foods programs for households (ie, The Emergency Food Assistance Program, Food Distribution Program on Indian Reservations, and Commodity Supplemental Food Program) according to the Healthy Eating Research (HER) Guidelines for the Charitable Food System. DESIGN: Review of the nutritional information of the foods available from USDA Foods programs for households was performed. Using the HER Guidelines, foods were categorized into a 3-tiered system (ie, choose often/green; choose sometimes/yellow; choose rarely/red) based on levels of saturated fat, sodium, and added sugar per serving, and presence of whole grains. SETTING: All unique foods available from The Emergency Food Assistance Program, Food Distribution Program on Indian Reservations, and Commodity Supplemental Food Program (n = 152) for fiscal year 2022 were evaluated. MAIN OUTCOME MEASURES: Nutritional quality of the foods available from USDA Foods programs for households according to the HER guidelines was measured. Foods were ranked green, yellow, red, or not ranked. STATISTICAL ANALYSES PERFORMED: The proportion of foods in each HER Guidelines' rank was calculated across the 3 USDA Foods programs for households and by each program. RESULTS: The majority of USDA Foods were ranked green (57.3%) or yellow (35.5%). A small number of items were ranked red (3.3%) or were unranked condiments or cooking staples (3.9%). CONCLUSIONS: The USDA Foods available in the household programs were primarily fruits and vegetables; lean proteins; whole grains; and low-fat dairy products that were consistent with national dietary guidelines. There is some room for improvement, and adjustments in the specifications for certain items are recommended to strengthen the nutritional value of the foods provided through these important federal programs.

Modeling lacto-vegetarian, pescatarian, and "pescavegan" USDA food patterns and assessing nutrient adequacy for healthy non-pregnant, non-lactating adults.

Introduction: The 2020-2025 Dietary Guidelines for Americans (DGA) includes a Healthy Vegetarian Dietary Pattern (HVDP) with dairy foods and eggs as one of its three recommended dietary patterns for non-pregnant, non-lactating healthy adults. This study evaluates whether pescatarian, lacto-vegetarian, and "pescavegan" adaptations of the HVDP can be nutritionally adequate if modeled with foods recommended by the DGA. Methods: The nutrient composition of these three alternative models of the HVDP were assessed at 1, 800-, 2, 000-, 2, 200-, and 2,400- kcal/day using similar food pattern modeling procedures as the 2020 DGA. For the pescatarian and pescavegan models, 0.5 ounce-equivalent of refined grains per day was replaced with seafood. For the lacto-vegetarian and pescavegan models, eggs were replaced with equal proportions of the other vegetarian protein foods. In the pescavegan model, dairy foods were replaced by a dairy alternative group comprised of fortified soy milk and soy yogurt. Results: All models at all energy levels were within Acceptable Macronutrient Distribution Ranges (AMDRs) for all macronutrients, contained ≤5% of total kcal from saturated fat, and met recommendations for most micronutrients. Nutrients provided below the Dietary Reference Intakes (DRIs) in these models included iron, sodium, vitamin D, vitamin E, and choline. Micronutrients provided at less than 50% of their respective DRIs included vitamin D and choline. Discussion: Adapting the HVDP for lactovegetarian, pescatarian, and pescavegan dietary patterns provided adequate amounts of macronutrients and most micronutrients.

Assessing the nutritional content and adequacy of food parcels among vulnerable Lebanese during a double crisis: COVID-19 pandemic and an economic meltdown.

OBJECTIVES: This study aimed to explore the nutritional content and quality of food parcels distributed in Lebanon and assess their adherence to dietary guidelines during the COVID-19 pandemic and an unprecedented economic crisis. DESIGN: Cross-sectional study (June-July 2020); phone survey (thirty items). SETTING: Lebanon. PARTICIPANTS: Food parcel providers (FPP; n 72) involved in food parcel distribution (FPD), mainly to Lebanese households. RESULTS: FPP included international non-governmental organizations (INGO) (n 3), local non-governmental organizations (n 45) and personal initiatives (n 24). Overall, low adherence to the World Food Programme (WFP) food parcel guidelines were observed among FPP for specific food items, including vegetables, fish, legumes and cereals, whereas salt content significantly surpassed the guidelines (all P-values <0·001). On average, a food parcel provided 608·4 ± 55 kcal/d/person. The greatest contributors to total energy intake (TE) in the food parcel were carbohydrates (46·4 %) and fats (46·8 %), while protein contributed to 7 %TE. In addition, %TE from fats and sugars significantly surpassed the dietary reference intakes (DRI) for a single person per d (134-234 % and 185 % of DRI, respectively, P-values <0·001). Only 10-15 % of daily needs for key micronutrients, including Fe, Zn, thiamin, riboflavin and dietary folate, were met through the food parcels. Adequate food safety and hygiene practices were reported among FPP, yet dramatic changes in food costs due to overlapping crises affected the quality and quantity of food in parcels. CONCLUSIONS: Findings highlight the need to improve the nutritional content of food parcels and adherence to dietary guidelines to alleviate food and nutrition insecurity while preventing diet-related diseases among vulnerable beneficiaries in Lebanon.

A qualitative study identifying challenges resulting from complex evidence on lifestyle factors and cancer: perspectives from Black and Latina cancer survivors and healthcare providers.

PURPOSE: Most breast cancer survivors have challenges with adopting healthy lifestyle behaviors. This may be due to contextual challenges that result from the complex nature of the evidence. To address this gap, we explored the experiences of breast cancer survivors of color and oncology healthcare providers. METHODS: Content analysis with inductive and deductive approaches was used for semi-structured interviews with 26 female breast cancer survivors and 10 oncology healthcare providers from Greater New Haven, Connecticut. RESULTS: Survivors identified substantial confusion on the evidence regarding lifestyle behaviors and breast cancer, stemming from inadequate healthcare provider counseling and an overreliance on informal sources of information. Providers identified lack of evidence-based knowledge as a barrier to counseling on these topics. There was a mixed perspective regarding the consistency of evidence, stemming from a combination of gaps in the available evidence and accessing evidence-based knowledge from a wide range of professional resources. Some providers perceived the guidelines as consistent; others felt guidelines were constantly changing, impacting how and on what they counseled. Therefore, many healthcare providers in oncology care relied on generic messaging on lifestyle behaviors after a cancer diagnosis. CONCLUSIONS: Inconsistent information sources, the rapidly changing evidence, and gaps in the current evidence contribute to generic messaging about lifestyle behaviors and may inhibit a survivor's ability to engage in behavior change. Consistent and uniform healthy lifestyle guidelines for cancer outcomes may address both provider and patient level barriers to knowledge.

Association between early nutrition support and 28-day mortality in critically ill patients: the FRANS prospective nutrition cohort study.

BACKGROUND: Current guidelines suggest the introduction of early nutrition support within the first 48 h of admission to the intensive care unit (ICU) for patients who cannot eat. In that context, we aimed to describe nutrition practices in the ICU and study the association between the introduction of early nutrition support (< 48 h) in the ICU and patient mortality at day 28 (D28) using data from a multicentre prospective cohort. METHODS: The 'French-Speaking ICU Nutritional Survey' (FRANS) study was conducted in 26 ICUs in France and Belgium over 3 months in 2015. Adult patients with a predicted ICU length of stay > 3 days were consecutively included and followed for 10 days. Their mortality was assessed at D28. We investigated the association between early nutrition (< 48 h) and mortality at D28 using univariate and multivariate propensity-score-weighted logistic regression analyses. RESULTS: During the study period, 1206 patients were included. Early nutrition support was administered to 718 patients (59.5%), with 504 patients receiving enteral nutrition and 214 parenteral nutrition. Early nutrition was more frequently prescribed in the presence of multiple organ failure and less frequently in overweight and obese patients. Early nutrition was significantly associated with D28 mortality in the univariate analysis (crude odds ratio (OR) 1.69, 95% confidence interval (CI) 1.23-2.34) and propensity-weighted multivariate analysis (adjusted OR (aOR) 1.05, 95% CI 1.00-1.10). In subgroup analyses, this association was stronger in patients ≤ 65 years and with SOFA scores ≤ 8. Compared with no early nutrition, a significant association was found of D28 mortality with early enteral (aOR 1.06, 95% CI 1.01-1.11) but not early parenteral nutrition (aOR 1.04, 95% CI 0.98-1.11). CONCLUSIONS: In this prospective cohort study, early nutrition support in the ICU was significantly associated with increased mortality at D28, particularly in younger patients with less severe disease. Compared to no early nutrition, only early enteral nutrition appeared to be associated with increased mortality. Such findings are in contrast with current guidelines on the provision of early nutrition support in the ICU and may challenge our current practices, particularly concerning patients at low nutrition risk. Trial registration ClinicalTrials.gov Identifier: NCT02599948. Retrospectively registered on November 5th 2015.

Position statement of the Polish Academy of Sciences Committee Human Nutrition Science on the principles for the nutrition of children aged 1-3 years.

The Position Statement on the principles of nutrition for children aged 1-3 years emphasizes that proper nutrition of children at this age determines their optimal psychometric development and has beneficial effects on the process nutritional programming, which reduces the risk of diet-related diseases in adulthood. Continued breastfeeding in the post-infancy period, together with the proper introduction of complementary foods, supplies all the nutritional needs of the child. A varied selection of food products is important to balance out the diet of a child in the context of energy and nutrient needs. Attention should be paid to products not recommended for frequent consumption, due to the possibility of the early development of improper eating habits that can lead to undesirable health consequences. Due to the potential risk of deficiency, adequate intake of iron, iodine, calcium and vitamin D, as well as of n-3 PUFAs (which is often insufficient) should be provided. Adequate dietary energy and protein intake protects children against protein-energy undernutrition and is crucial for their proper growth and development. An important element in the assessment of the development of children involves monitoring their nutritional status and physical development by systematically measuring their body weight and length/height and analyzing their weight gain. It is necessary to diagnose the causes of being underweight/overweight in children. Physical activity (such as outdoor walks, plays, and games) and healthy sleep hygiene are recommended. Physical activity, an adequate number of hours of sleep, and the quality of sleep in early childhood may improve immunity, reduce the risk of excessive weight gain, and consequently reduce the risk of obesity later in life. Other issues discussed include the functioning of the digestive system as one of the determinants of the nutrition of young children, basics of proper nutrition, risk of nutrient deficiencies and development of proper eating habits in early childhood.

Nutrition and Wound Care.

Nutrition is an important component of health and well-being. A compromised nutritional status has been linked to increased risk for wound development, difficulty managing, and decreased wound healing rate. Malnutrition contributes to an immunocompromised system, reduced collagen synthesis, and diminished tensile strength during the wound healing process. This is why assessment and optimization of nutritional status should be incorporated as part of a comprehensive treatment plan for individuals with wounds. The nutrition care plan must include individualized interventions designed to address the individual's nutrition diagnosis. This article reviews the role of nutrition in wound prevention, management, and treatment.

Young Child Nutrition: Knowledge and Surveillance Gaps across the Spectrum of Feeding.

The first 1000 days is a critical window to optimize nutrition. Young children, particularly 12-24 month-olds, are an understudied population. Young children have unique nutrient needs and reach important developmental milestones when those needs are met. Intriguingly, there are differences in the dietary patterns and recommendations for young children in the US vs. globally, notably for breastfeeding practices, nutrient and food guidelines, and young child formulas (YCFs)/toddler drinks. This perspective paper compares these differences in young child nutrition and identifies both knowledge gaps and surveillance gaps to be filled. Parental perceptions, feeding challenges, and nutrition challenges are also discussed. Ultimately, collaboration among academia and clinicians, the private sector, and the government will help close young child nutrition gaps in both the US and globally.

Adherence to the Mediterranean Diet: Impact of Geographical Location of the Observations.

The Mediterranean diet has emerged as a comprehensive lifestyle, including specific foods and meal composition and a set of behavioural and social features. Adherence to the Mediterranean diet has been shown to promote health and reduce the prevalence of chronic diseases. The actual implementation of the Mediterranean diet is affected by several sociocultural factors as well as geographical components. Indeed, the geographical location, such as a specific country or different areas in a country and specific latitude and climate, appears to be an important factor that may strongly affect the implementation of the Mediterranean diet or some of its principles as well as the adherence to it. Another dynamic component affecting personal nutritional choices, also regarding adherence to the Mediterranean diet and its principles, is the individual life-long trajectory of food preference and nutrition habits and awareness. In this review, we discuss the current evidence on the impact of geographical location on adherence to the Mediterranean diet.

Modeling Dairy-Free Vegetarian and Vegan USDA Food Patterns for Nonpregnant, Nonlactating Adults.

BACKGROUND: The 2020-2025 Dietary Guidelines for Americans (2020 DGA) recommend 3 dietary patterns for Americans, including a Healthy Vegetarian Dietary Pattern (HVDP). OBJECTIVES: The objective of this study was to assess whether nutritionally adequate dairy-free and vegan adaptations to the HVDP can be modeled with foods already in the DGA. METHODS: Using similar food pattern modeling procedures as the 2020 DGA, the nutrient composition of 2 alternative models-dairy-free and vegan-of the 1800-, 2000-, 2200-, and 2400-kcal/d HVDPs was assessed. The dairy food group was replaced with a dairy alternative group comprised of soy milk and soy yogurt fortified with calcium, vitamin A, and vitamin D. For the vegan model, eggs were replaced with equal proportions of vegetarian protein foods. RESULTS: Dairy-free and vegan models required minimal changes to the HVDP. Cup-equivalents and/or ounce-equivalents of vegetables, fruits, grains, oils, and discretionary calories remained unchanged. Content of total fat, polyunsaturated fat, linoleic acid (18:2n-6), linolenic acid, iron, copper, vitamin D, riboflavin, vitamin B-12, and vitamin K increased in both models by ≥10% (all comparisons relative to the original HVDP). Choline increased ≥25% in the dairy-free models. Protein decreased 11% in both 1800-kcal/d models and 10% in both 2000-kcal/d models. Sodium, cholesterol, zinc, and phosphorus decreased across all energy levels in both models, and selenium decreased in the vegan model. Carbohydrate, fiber, saturated fat, EPA, DHA, calcium, magnesium, potassium, vitamin A, vitamin E, vitamin C, thiamin, folate, and vitamin B-6 changed ≤10%. Both models contained adequate nutrients to meet Dietary Reference Intakes (DRIs) for most age and sex groups for which 1800-, 2000-, 2200-, and 2400-kcal/d diets are appropriate. Zinc was the only nutrient below the DRI for males. CONCLUSIONS: The dairy-free and vegan HVDP models could help adults who do not consume dairy foods and/or other animal products to meet nutrition recommendations.

How Is Context Addressed in Growth Monitoring? A Comparison of the Tanzanian, Indian, and Dutch Manuals.

Background: To address malnutrition in all its forms, context should be taken into account in growth-monitoring (GM) practices. Objectives: The aim was to compare GM manuals of countries with different nutrition problems, and to assess how these manuals are adapted to the different biological, socioeconomic, and cultural contexts. Methods: GM manuals from Tanzania, India, and the Netherlands were compared with each other, and with the materials for the WHO training course on child growth assessment. First, the aims of GM, growth measurements, interpretation of these measurements, and counseling approaches are compared. Second, contextual determinants of malnutrition are identified using the UNICEF framework for malnutrition as an analytical model. Results: Our results show that the GM manuals differ in their descriptions of the aim of GM, growth measurements, their interpretation, and counseling approaches. Assessing normal growth and detecting growth problems are among the aims of GM in all of the analyzed countries. In Tanzania and India, the focus is mainly on undernutrition, whereas the Dutch manuals focus on overweight and on underlying pathologies that contribute to poor linear growth. The findings of our analysis of contextual factors within the UNICEF framework show that the Tanzanian protocol is only minimally adapted to the local context. Of the manuals examined in our study, the Indian manual is most focused on the contextual determinants of malnutrition, and stresses the importance of taking customs and beliefs into account. The Dutch protocol, by contrast, emphasizes the importance of the biological environment, including parental height and ethnicity, as determinants of child growth. Conclusions: The country manuals we analyzed only partly reflect the contexts in which children live. To address malnutrition in all its forms, the GM manuals should take children's biological, socioeconomic, and cultural contexts into account, as this would help health professionals to tailor counseling messages for parents.

Adherence to Clinical Practice Guideline Recommendations in Women with Gestational Diabetes and Associations with Maternal and Infant Health-A Cohort Study.

Gestational diabetes mellitus (GDM) is managed by dietary advice, but limited evidence exists about the impact of adherence on health. We assessed whether adherence to the New Zealand Ministry of Health dietary recommendations is associated with maternal and infant health in women with GDM. Data from 313 women with GDM were used. Adherence to food-related recommendations was scored from 0 (no adherence) to 10 (adhered to all recommendations) and analysed in tertile groups (high, moderate, low adherence). Adherence to visiting a dietitian and appropriate weight gain were assessed as yes or no. Chi-square, ANOVA, and odds ratios were used to compare groups. High dietary adherence compared to low adherence was associated with reduced oral hypoglycaemic and insulin use (OR = 0.55, CI = 0.30-1.00). Visiting a dietitian compared to not was associated with increased oral hypoglycaemic and insulin use (OR = 2.96, CI = 1.12-7.80), decreased odds of a large-for-gestational-age infant (OR = 0.32, CI = 0.14-0.73) and neonatal hyperbilirubinaemia (OR = 0.27, CI = 0.08-0.95). Greater than recommended compared with recommended weight gain was associated with increased oral hypoglycaemic and insulin use (OR = 2.51, CI = 1.26-5.01), while lower than recommended weight gain was associated with decreased postpartum haemorrhage (OR = 0.45, CI = 0.23-0.91) and increased breastfeeding (OR = 1.96, CI = 1.04-3.70). Adherence to dietary recommendations for women with GDM likely improves health outcomes.

Nutritional considerations of a paediatric gluten-free food guide for coeliac disease.

The gluten-free (GF) diet is the only treatment for coeliac disease (CD). While the GF diet can be nutritious, increased reliance on processed and packaged GF foods can result in higher fat/sugar and lower micronutrient intake in children with CD. Currently, there are no evidence-based nutrition guidelines that address the GF diet. The objective of this cross-sectional study was to describe the methodological considerations in forming a GF food guide for Canadian children and youth (4-18 years) with CD. Food guide development occurred in three phases: (1) evaluation of nutrient intake and dietary patterns of children on the GF diet, (2) pre-guide stakeholder consultations with 151 health care professionals and 383 community end users and (3) development of 1260 GF diet simulations that addressed cultural preferences and food traditions, diet patterns and diet quality. Stakeholder feedback identified nutrient intake and food literacy as important topics for guide content. Except for vitamin D, the diet simulations met 100 % macronutrient and micronutrient requirements for age-sex. The paediatric GF plate model recommends intake of >50 % fruits and vegetables (FV), <25 % grains and 25 % protein foods with a stronger emphasis on plant-based sources. Vitamin D-fortified fluid milk/unsweetened plant-based alternatives and other rich sources are important to optimise vitamin D intake. The GF food guide can help children consume a nutritiously adequate GF diet and inform policy makers regarding the need for nutrition guidelines in paediatric CD.

Evaluation of a paediatric gluten-free food guide by children and youth with coeliac disease, their parents and health care professionals.

There are currently no universal evidence-based nutrition guidelines that address the gluten-free (GF) diet for children/youth (4-18 years). A GF food guide was created to help children/youth with coeliac disease (CD) and their families navigate the complexities of following a GF diet. Guide formation was based on pre-guide stakeholder consultations and an evaluation of nutrient intake and dietary patterns. The study objective was to conduct an evaluation on guide content, layout, feasibility and dissemination strategies from end-stakeholder users (children/youth with CD, parents/caregivers and health care professionals). This is a cross-sectional study using a multi-method approach of virtual focus groups and an online survey to conduct stakeholder evaluations. Stakeholders included children/youth (4-18 years), their parents/caregivers in the coeliac community (n 273) and health care professionals (n 80) with both paediatric and CD experience from across Canada. Thematic analysis was performed on focus group responses and open-ended survey questions until thematic saturation was achieved. χ2 and Fisher's exact statistical analyses were performed on demographic and close-ended survey questions. Stakeholders positively perceived the guide for content, layout, feasibility, ethnicity and usability. Stakeholders found the material visually appealing and engaging with belief that it could effectively be used in multi-ethnic community and clinical-based settings. Guide revisions were made in response to stakeholder consultations to improve food selection (e.g. child-friendly foods), language (e.g. clarity) and layout (e.g. organisation). The evaluation by end-stakeholders provided practical and patient-focused feedback on the guide to enable successful uptake in community and clinical-based settings.

Dietary Saturated Fats and Health: Are the U.S. Guidelines Evidence-Based?

The last decade has seen nearly 20 papers reviewing the totality of the data on saturated fats and cardiovascular outcomes, which, altogether, have demonstrated a lack of rigorous evidence to support continued recommendations either to limit the consumption of saturated fatty acids or to replace them with polyunsaturated fatty acids. These papers were unfortunately not considered by the process leading to the most recent U.S. Dietary Guidelines for Americans, the country's national nutrition policy, which recently reconfirmed its recommendation to limit saturated fats to 10% or less of total energy intake, based on insufficient and inconsistent evidence. Continuation of a cap on saturated fat intake also fails to consider the important effects of the food matrix and the overall dietary pattern in which saturated fatty acids are consumed.