Dietary behaviours in the context of nutrition transition: a systematic review and meta-analyses in two African countries.

OBJECTIVE: To synthesise evidence of urban dietary behaviours (macronutrients, types of foods, dietary diversity and dietary practices) in two African countries in relation to postulated changes in the context of nutrition transition. DESIGN: Systematic review and meta-analyses, including six online databases and grey literature, 1971-2018 (Protocol CRD42017067718). SETTING: Urban Ghana and Kenya. PARTICIPANTS: Population-based studies of healthy adolescents and adults. RESULTS: The forty-seven included studies encompassed 20 726 individuals plus 6526 households. Macronutrients were within WHO-recommended ranges: mean energy intake was 1867 kcal/d (95 % CI 1764, 1969) and the proportions of macronutrients were carbohydrate 61·2 % (58·4, 64·0), fat 25·3 % (22·8, 28·0) and protein 13·7 % (12·3, 15·1). The proportion of population consuming fruit and vegetables was 51·6 %; unhealthy foods, 29·4 %; and sugar-sweetened beverages (SSBs), 39·9 %. Two-thirds (68·8 %) consumed animal-source proteins. Dietary diversity scores were within the mid-range. Meal patterns were structured (typically three meals per day), with evidence lacking on snacking or eating out. CONCLUSIONS: Population-level diets fell within WHO macronutrient recommendations, were relatively diverse with structured meal patterns, but some indications of nutrition transition were apparent. The proportion of population consuming fruit and vegetables was low compared to healthy-eating recommendations, and consumption of SSBs was widespread. A paucity of evidence from 1971 to 2010 precluded a longitudinal analysis of nutrition transition. Evidence from these two countries indicates which aspects of dietary behaviours may be contributing to increasing overweight/obesity, namely a low proportion of population consuming fruit and vegetables and widespread consumption of SSBs. These are potential targets for promoting healthier diets.

Calcium intake in high-risk pregnant women assisted in a high-complexity hospital.

Pregnancy is characterized by physiological changes. One of these changes involves calcium. During this period, an increased in calcium excretion occurs as well as an increased intestinal absorption and renal reabsorption, so that the adequate growth and development of the fetus can happen. Low calcium intake is associated with chronic diseases, such as diabetes and hypertension, which have negative impact on both mother and fetus. This study aimed to evaluate the average calcium intake of high-risk pregnant women, assisted in a clinic of high complexity service and correlated with chronic diseases. To perform this study, it was used a food frequency questionnaire. As a result, high-risk pregnant women showed daily calcium intake lower than the recommended by DRI during this period. Hypertensive or diabetic pregnant women showed lower average intake of calcium. Significant association between calcium intake and nutritional status was not observed. Calcium supplementation was present, however, at low percentage in the groups with hypertensive pregnant women. To analyze the relation between calcium intake and the comorbidities, as well as calcium intake and the nutritional status of the pregnant women, it was used one-way analysis of variance and Bonferroni multiple comparison. Further studies are required for evaluating other parameters that justify the low calcium intake among this population group, and the definition of pathways for the management of the nutritional deficit considering the possible damage to maternal and neonatal health in the short and long term.

New Reference Values for Energy Intake.

The reference values for energy intake of the German, Austrian and Swiss nutrition societies for children, adolescents and adults are derived using the factorial method. For adults, a mean BMI of 22 kg/m(2) is taken as a basis given the current mean body size for adults residing in Germany (taken from the German Health Interview and Examination Survey for Adults, DEGS1). The determination of the energy expenditure for infants is based on data obtained using the doubly labelled water (DLW) method. The energy storage in growing tissue will be added for the purpose of deriving reference values for this age group. For pregnant women, given an increase in body weight of 12 kg during pregnancy, guiding values for additional energy intake in the second trimester of 250 kcal/day and in the third trimester of 500 kcal/day are indicated using DLW data sets and taking energy storage in growing tissue into account. In case of overweight prior to pregnancy as well as in the case of reduced physical activity during pregnancy, the additional requirement is lower. For women exclusively breastfeeding during the first 4-6 months, the guiding value for additional energy intake is quoted as 500 kcal/day.

[Bone and Nutrition. Vitamin D intake and bone].

Vitamin D insufficiency is one of the risk factors of osteoporosis. To know the vitamin D intake for the prevention of bone loss and fracture, it is necessary to evaluate the appropriate serum 25-hydroxyvitamin D (25-D) concentration for bone health, and the vitamin D intake to maintain its concentration. Although vitamin D intake 15 and 20 µg/d have been set as RDA (Recommended Dietary Allowance) in USA/Canada DRIs (Dietary reference intakes), 5.5 µg/d has been set as AI (adequate intake) in Japanese DRIs (2015). While reference values in Japan and USA/Canada were quite different, both DRIs are common in that it aim to maintain the serum 25-D concentration to more than 50 nmol/L. In the present review, vitamin D intakes and bone health, vitamin D status in Japanese people, DRIs for vitamin D and improvement of vitamin D insufficiency are reviewed.

EURRECA-Principles and future for deriving micronutrient recommendations.

The EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence (NoE) explored an approach for setting micronutrient recommendations, which would address the variation in recommendations across Europe. Therefore, a framework for deriving and using micronutrient Dietary Reference Values (DRVs) has been developed. This framework comprises four stages (defining the problem-monitoring and evaluating-deriving dietary reference values-using dietary reference values in policy making). The aim of the present paper is to use this framework to identify specific research gaps and needs related to (1) knowledge available on specific micronutrients (folate, iodine, iron, selenium, vitamin B12, vitamin D, and zinc) and (2) the methodology presented in the framework. Furthermore, the paper describes the different outputs that support the process like protocols, guidelines, systematic review databases, and peer-reviewed publications, as well as the principal routes of dissemination of these outputs to ensure their optimal uptake in policy, practice, and research collaborations. The importance of ensuring transparency in risk assessment and risk management, systematic searching the literature, and taking into account policy options is highlighted. [Supplementary materials are available for this article. Go to the publisher's online edition of Critical Reviews in Food Science and Nutrition for the following free supplemental files: Additional tables.].

[Gut microbiota and grain fiber: evidence and practical recommendations]. / Microbiota intestinal y fibra de cereales: evidencia y recomendaciones prácticas.

INTRODUCTION: Modulation of the human gut microbiota is emerging as a plausible approach to promoting health and preventing and treating disease. Changes in dietary macronutrients, mainly in carbohydrates, exert specific effects on the human gut microbiota. Specifically, there is evidence that supports that dietary fiber may influence the abundance, diversity, and metabolism of the human gut microbiota. This work contributes to the understanding of the impact of intact cereal fiber consumption on the gut microbiota of healthy adults. The strongest evidence points to the role of wheat bran and wholegrain wheat fiber promoting gut microbiota diversity, since wheat fiber demonstrated the most consistent prebiotic effects, with demonstrable effects, with an increase in wheat fiber as low as 6 g/day.

INTRODUCCIÓN: La modulación de la microbiota intestinal está emergiendo como un enfoque plausible para promover la salud así como la prevención y el tratamiento de las enfermedades. Los cambios en los macronutrientes de la dieta tienen efectos específicos sobre la microbiota intestinal de los individuos. Específicamente, existe evidencia que sugiere que la fibra dietética puede modificar la abundancia, la diversidad y el metabolismo de la microbiota intestinal. Este trabajo contribuye a la comprensión del impacto del consumo de las fibras intactas de los cereales sobre la microbiota intestinal. La evidencia más sólida apunta al papel del salvado de trigo y la fibra de trigo integral como promotores de la diversidad de la microbiota intestinal, ya que la fibra de trigo demostró los efectos prebióticos más consistentes, con un aumento de tan solo 6 g al día.

Sugars, Salt, Saturated Fat and Fibre Purchased through Packaged Food and Soft Drinks in Europe 2015-2018: Are We Making Progress?

The availability, purchase and consumption of foods high in fat, sugars and salt and low in fibre are linked to the high health and economic burden of noncommunicable diseases, including cancer, in Europe. Therefore, assessing the quality of the food offer is key as feedback to decision makers, as well as to identify good practices and areas of the food supply still requiring urgent action. We combined detailed market share and sales data with nutrition composition data to evaluate the nutritional quality of 14 packaged food and soft drinks categories sold across 22 European countries over the 2015-2018 period. Our analysis shows great variability of the nutritional composition within and among packaged food and soft drinks categories across European countries. Our estimates of the market-share weighted mean, a measure that integrates possible changes in nutrient content with the amount of a product sold to consumers, as well as daily per capita nutrient sale estimates, suggest a small but statistically significant progress in certain food categories only. Overall, the amounts of sugars, saturated fat, salt and fibre being sold to European citizens through these products is not improving to an extent to meet public health objectives.

Water Researchers Do Not Have a Strategic Plan for Gathering Evidence to Inform Water Intake Recommendations to Prevent Chronic Disease.

Confusion has persisted for decades in the United States (U.S.) over how much plain water to drink, despite national water intake recommendations which are based on high quality scientific evidence. This editorial summarizes the definition, alignment and coordination of evidence that informs the current U.S. adequate intake (AI) recommendations for water. It highlights gaps in the evidence that perpetuate confusion and opportunity to address the gaps through strategic planning.

Addressing Nutritional Gaps: Simple Steps for the Primary Care Provider.

Identify common shortfalls in the typical American diet. Address the link between poor diet quality and chronic disease. Identify patients at risk for vitamin deficiency and potential vitamin-drug interactions. Recognize patients with vitamin and mineral deficiencies. Partner with patients regarding selection and appropriate use of vitamin and mineral supplements to achieve recommended dietary allowances.

Saturated Fats and Health: A Reassessment and Proposal for Food-Based Recommendations: JACC State-of-the-Art Review.

The recommendation to limit dietary saturated fatty acid (SFA) intake has persisted despite mounting evidence to the contrary. Most recent meta-analyses of randomized trials and observational studies found no beneficial effects of reducing SFA intake on cardiovascular disease (CVD) and total mortality, and instead found protective effects against stroke. Although SFAs increase low-density lipoprotein (LDL) cholesterol, in most individuals, this is not due to increasing levels of small, dense LDL particles, but rather larger LDL particles, which are much less strongly related to CVD risk. It is also apparent that the health effects of foods cannot be predicted by their content in any nutrient group without considering the overall macronutrient distribution. Whole-fat dairy, unprocessed meat, and dark chocolate are SFA-rich foods with a complex matrix that are not associated with increased risk of CVD. The totality of available evidence does not support further limiting the intake of such foods.

Growing the Business of Whole Grain in the Australian Market: A 6-Year Impact Assessment.

The Australia New Zealand Food Standards Code does not regulate on-pack claims describing the amount of whole grain in foods. In July 2013, The Grains & Legumes Nutrition CouncilTM (GLNC) established a voluntary Code of Practice for Whole Grain Ingredient Content Claims (the Code) providing guidance for whole grain claims, with cut-off values and suggested wording ≥8 g, ≥16 g, and ≥24 g per manufacturer serve (contains; high and very high in whole grain), based on a 48 g whole grain daily target intake. The aim of this impact assessment was to report the uptake of the Code by manufacturers, changes in numbers of whole grain products, and claims on-pack since 2013, including compliance. The impact assessment was undertaken in August 2019, comparing current registered manufacturers ("users") and their products to the total number of products in the market deemed eligible for registration through GLNC product audits since 2013. Reporting included breakfast cereals, bread products, crispbreads, crackers, rice/corn cakes, rice, pasta, noodles, couscous, other grains (e.g., quinoa, buckwheat, freekeh), and grain-based muesli bars. As of 30 June 2019, there were 33 registered users and 531 registered products in Australia and New Zealand representing 43% of the eligible manufacturers and 65% of the eligible whole grain foods. Three-quarters (78% and 74%) of the eligible breakfast cereals and bread products were registered with the Code in 2019, followed by 62% of grain-based muesli bars. Only 39% of crispbread, crackers, rice/corn cakes, and rice, pasta, noodles, couscous, and other grains were registered. From 2013 there has been a 71% increase in the number of whole grain foods making claims, demonstrating strong uptake by industry, with clearer, more consistent, and compliant on-pack communication regarding whole grain content.

Milestones in DRI Development: What Does the Future Hold?

The state of nutritional health in the United States in the early part of the twentieth century was very different from today. Nutrient deficiencies and dental caries were prevalent health concerns for many Americans. In 1940, the US National Defense Advisory Commission asked the National Academy of Sciences for help in studying problems of nutrition in the United States. The outcome was issuance of the first RDAs. The goal of the RDAs was to recommend "…allowances sufficiently liberal to be suitable for maintenance of good nutritional status." In the subsequent decades, a very different nutritional health challenge began to emerge for an increasing proportion of the population, that of overweight and obesity and risk of diet-related chronic disease. In part, as a response to this challenge, the RDA process was revised and the Dietary Reference Intakes (DRIs) were developed. The DRIs are a set of reference values that, when adhered to, predict a low probability of nutrient inadequacy or excessive intake. Recently, new DRI guidelines were proposed to define reference points for nutrient and food component intakes that influence risk of chronic disease. Developing DRIs for chronic disease endpoints presents unique challenges, notably, chronic diseases are multifactorial in nature and not directly nutrient-specific; the body of evidence supporting nutrients and other food substances as modifiers of risk of chronic disease is generally limited; and there is a lack of consistency in findings across study types. In addition, the latency of dietary exposures and chronic disease outcomes makes it difficult to demonstrate causality. Adapting the DRI model to meet the needs of the general population in the current context suggests a need to redefine the boundaries that describe the health of the population and to re-examine how indicators of chronic disease can be integrated effectively into the DRI process.

Tracking Kids' Food: Comparing the Nutritional Value and Marketing Appeals of Child-Targeted Supermarket Products Over Time.

Marketing unhealthy foods negatively impacts children's food preferences, dietary habits and health, prompting calls for regulations that will help to create an "enabling" food environment for children. One powerful food marketing technique is product packaging, but little is known about the nature or quality of child-targeted food products over time. This study assesses how child-targeted supermarket foods in Canada have transformed with respect to nutritional profile and types of marketing appeals (that is, the power of such marketing). Products from 2009 (n = 354) and from 2017 (n = 374) were first evaluated and compared in light of two established nutritional criteria, and then compared in terms of marketing techniques on packages. Overall, child-targeted supermarket foods did not improve nutritionally over time: 88% of child-targeted products (across both datasets) would not be permitted to be marketed to children, according to the World Health Organization (WHO) criteria, and sugar levels remained consistently high. Despite this poor nutritional quality, the use of nutrition claims increased significantly over time, as did the use of cartoon characters and appealing fonts to attract children's attention. Character licensing-using characters from entertainment companies-remained consistent. The findings reveal the critical need to consider packaging as part of the strategy for protecting children from unhealthy food marketing. Given the poor nutritional quality and appealing nature of child-oriented supermarket foods, food product packaging needs to be included in the WHO's call to improve the restrictions on unhealthy food marketing to children.

Differences in Dietary Intakes among Lebanese Adults over a Decade: Results from Two National Surveys 1997-2008/2009.

Amidst the ongoing societal and economic shifts in the Eastern Mediterranean region (EMR), this study aims at investigating temporal trends in food consumption and nutrient intakes among Lebanese adults, by age and sex. Data were derived from two national cross-sectional surveys conducted in Lebanon during two time periods (1997; 2008/2009). In both surveys, dietary assessment was based on 24-h recalls. The results, expressed as % energy intake (%EI), revealed a significant decrease (p < 0.001) in the consumption of bread, fruits, fresh fruit juices, milk and eggs, whereas the consumption of added fats and oils, poultry, cereals and cereal-based products, chips and salty crackers, sweetened milk and hot beverages increased over time (p < 0.001). A significant increase in dietary energy (kcal/day) and fat intake (%EI) was observed, coupled with decreases in carbohydrate intake (%EI) and dietary density of vitamin A and vitamin C (per 1000 kcal) (p < 0.001). These changes were noted in both genders and across age groups, albeit there were some disparities between groups. In conclusion, based on national nutrition surveys, this study is the first to characterize the nutrition transition in a middle-income country of the EMR, shedding light on priority areas for nutrition policies and interventions.

Vitamin D and cardio-metabolic biomarkers: small-scale comparative study between Libyan migrants and resident women in Serbia.

Libyan women are at high risk of vitamin D deficiency, mostly due to their lifestyle and low exposure to sun. In the last decades, Libyan residents have been forced to seek refuge in countries such as Serbia, a country with high incidence of cardio-metabolic diseases. Serbian residents tend to be deficient in vitamin D, mostly due to the lack of vitamin D fortification policy. The aim of this study was to evaluate vitamin D status in Libyan adult women migrating to Serbia, with the assessment of cardio-metabolic and nutritional biomarkers, including erythrocytes fatty acid composition, magnesium concentration, and dietary intake. The same markers were measured in Serbian women, and comparisons between the groups were made. Despite low vitamin D dietary intake in both study groups, we observed lower plasma vitamin D status in Libyan women. This was accompanied by a significantly lower concentration of magnesium in Libyan women. Libyan women had significantly higher omega-3 index and lower n-6/n-3 ratio in erythrocytes' phospholipids. We observed significant negative correlation between vitamin D and n-6 polyunsaturated fatty acids (PUFA) concentrations in both study groups. Despite lower vitamin D status in the Libyan group, erythrocyte fatty acid composition, along with blood lipids' concentrations, indicated a lower cardiovascular risk. Based on our results, the discrepancy in the vitamin D status could not be ascribed to the participants' dietary intake of the micronutrient, rather is potentially associated with ethnic-specific cardio-metabolic profile, which should be confirmed in larger cohorts.

The International Consortium for Quality Research on Dietary Sodium/Salt (TRUE) position statement on the use of 24-hour, spot, and short duration (<24 hours) timed urine collections to assess dietary sodium intake.

The International Consortium for Quality Research on Dietary Sodium/Salt (TRUE) is a coalition of intentional and national health and scientific organizations formed because of concerns low-quality research methods were creating controversy regarding dietary salt reduction. One of the main sources of controversy is believed related to errors in estimating sodium intake with urine studies. The recommendations and positions in this manuscript were generated following a series of systematic reviews and analyses by experts in hypertension, nutrition, statistics, and dietary sodium. To assess the population's current 24-hour dietary sodium ingestion, single complete 24-hour urine samples, collected over a series of days from a representative population sample, were recommended. To accurately estimate usual dietary sodium at the individual level, at least 3 non-consecutive complete 24-hour urine collections obtained over a series of days that reflect the usual short-term variations in dietary pattern were recommended. Multiple 24-hour urine collections over several years were recommended to estimate an individual's usual long-term sodium intake. The role of single spot or short duration timed urine collections in assessing population average sodium intake requires more research. Single or multiple spot or short duration timed urine collections are not recommended for assessing an individual's sodium intake especially in relationship to health outcomes. The recommendations should be applied by scientific review committees, granting agencies, editors and journal reviewers, investigators, policymakers, and those developing and creating dietary sodium recommendations. Low-quality research on dietary sodium/salt should not be funded, conducted, or published.

Dietary Nitrate and Diet Quality: An Examination of Changing Dietary Intakes within a Representative Sample of Australian Women.

Dietary nitrate is increasingly linked to a variety of beneficial health outcomes. Our purpose was to estimate dietary nitrate consumption and identify key dietary changes which have occurred over time within a representative sample of Australian women. Women from the 1946⁻1951 cohort of the Australian Longitudinal Study on Women's Health with complete food frequency questionnaire data for both 2001 and 2013 were included for analysis. Dietary nitrate intakes were calculated using key published nitrate databases. Diet quality scores including the Australian Recommended Food Score, the Mediterranean Diet Score and the Nutrient Rich Foods Index were calculated along with food group serves as per the Australian Dietary Guidelines. Wilcoxon matched pairs tests were used to test for change in dietary intakes and Spearman's correlations were used to examine associations. In our sample of 8161 Australian women, dietary nitrate intakes were on average 65⁻70 mg/day, and we detected a significant increase in dietary nitrate consumption over time (+6.57 mg/day). Vegetables were the primary source of dietary nitrate (81⁻83%), in particular lettuce (26%), spinach (14⁻20%), beetroot (10⁻11%), and celery (7⁻8%) contributed primarily to vegetable nitrate intakes. Further, increased dietary nitrate intakes were associated with improved diet quality scores (r = 0.3, p < 0.0001). Although there is emerging evidence indicating that higher habitual dietary nitrate intakes are associated with reduced morbidity and mortality, future work in this area should consider how dietary nitrate within the context of overall diet quality can facilitate health to ensure consistent public health messages are conveyed.

The Decreasing Trend in Dietary Glycaemic Index and Glycaemic Load in Australian Children and Adolescents between 1995 and 2012.

This study aims to examine whether there were changes between 1995⁻2012 in the dietary glycaemic index (dGI) and glycaemic load (dGL) in Australian children (<16 years) according to three national surveys in 1995 (1995NS), 2007 (2007NS), and 2011⁻2012 (2012NS). Glycaemic index (GI) values of foods were assigned using published methodology. Plausible 24-h recall data from the 1995NS, 2007NS and 2012NS (weighted n = 2475, 4373 and 1691 respectively) were compared for differences in dGI and dGL, and the contribution to dGL from different foods using one-way ANOVA with Bonferroni post hoc comparisons and linear regression. Decreasing trends across surveys were found in dGI and dGL (p < 0.001). Between 1995 and 2012, dGI and dGL per Megajoule (MJ) dropped by 2% and 6% respectively. The per capita dGL contribution from breads and bread rolls, fruit and vegetable juices, sweetened beverages and potatoes showed strong decreasing trends (R² > 0.7). Our findings suggest that dGI and dGL of Australian youths declined between 1995 to 2012, which may be due to increased awareness of the GI concept and healthy diet, widened food choices and immigrants with diverse dietary habits. This may lower the future risks of chronic degenerative diseases in Australian youths.