Nutrition and Transplant Outcomes

New Findings from the Feeding Infants and Toddlers Study: Data to Inform Action

Purpose: The purpose of this study was to evaluate dietary habits, food intakes, nutrient intakes, and diet quality of nonalcoholic fatty liver disease in a health screening and promotion center. Methods: The total number of study subjects was 10,111 adults, where 3087 subjects (30.5%) were diagnosed as NAFLD. The dietary intakes were obtained using a food frequency questionnaire. They were then compared with the dietary reference intakes could be used in the future for development of diet and nutrition guidelines s (KDRIs). Results: Mean age of subjects in the normal group was 52.9±10.3 yrs and body mass index (BMI) was 22.4 ± 2.6 kg/m², and those of the NAFLD group were 55.1 ± 9.2 yrs and 25.4 ± 2.9 kg/m². BMI, blood pressure of the NAFLD group were significantly higher than those of the normal group. The rates of skipping breakfast, overeating, and eating out were significantly could be used in the future for development of diet and nutrition guidelines er in the NAFLD group (p < 0.05, p < 0.000, p < 0.000 respectively). The speed of eating was fast in the NAFLD group (p < 0.000). The NAFLD group consumed significantly higher amounts of grains, meats, fish, seaweeds, kimchies, sugars, sweets, coffee, teas, and oils compared to the normal group (p < 0.05). Meanwhile, intakes of starch products, fruits, milk, and milk products were significantly lower in the NAFLD group compared with those of the normal group (p < 0.05). Riboflavin, calcium, and dietary fiber nutrient adequacy ratio (NAR) of the NAFLD group were significantly lower than those of the normal group. The Koreans dietary diversity score (KDDS) of the NAFLD group was lower than that of the normal group. Conclusion: In conclusion, we suggest that diet guidelines, such as increasing the intake of calcium and dietary fiber, reducing the intake of energy, fat, and simple carbohydrates, are necessary to improvement of NAFLD. The results could be used in the future for development of diet and nutrition guidelines for NAFLD.

Updating the Dietary Guidelines for Americans: Status and Looking Ahead

BackgroundAmong its recommended dietary patterns for Americans, including lactating mothers, the 2020 Dietary Guidelines for Americans (DGA) includes a Healthy Vegetarian Dietary Pattern (HVDP). However, the DGA does not provide guidance for adapting the HVDP for vegetarians who avoid dairy (ovo-vegetarian) or eggs (lacto-vegetarian), eat fish (pescatarians), or avoid all animal foods (vegan). ObjectiveTo determine whether models of the HVDP for different vegetarian diets could provide sufficient nutrition during lactation, a life stage with unique nutrient needs. MethodsAdaptations of the HVDP were developed at the 2200 and 2400 kcal levels using similar methods to the 2020 DGA. We compared these models with both the original HVDP and Dietary Reference Intakes (DRIs) for women ages 19 to 30 and ages 31 to 50 during lactation mo 1 to 12. All models were developed both with and without the addition of a multivitamin and -mineral prenatal supplement, commonly consumed by women throughout lactation. ResultsAll models (original HVDP, ovo-vegetarian, lacto-vegetarian, pescatarian, vegan) at all energy levels met the Adequate Macronutrient Distribution Ranges. Like the original HVDP and other dietary patterns in the DGA, the vegetarian adaptations in this study did not contain enough vitamin D, vitamin E, or choline to meet DRIs across all models and energy levels. With the prenatal supplement added, the models did not contain enough sodium, vitamin D, or choline. Some models also contained < 100% of the DRIs for sodium, zinc, vitamin A, and vitamin B6. Amounts of all other micronutrients met DRIs. ConclusionsAdaptations of the HVDP can provide adequate amounts of most nutrients, including nutrients of concern, during lactation to meet the needs of mothers during this life stage.

Objective: The Healthy Mediterranean-Style Eating Pattern (HMEP) in the 2015 Dietary Guidelines for Americans (DGA) recommends that adults eating less than 2400 kcal a day consume only two daily servings (or cup-equivalents) of low-fat or fat-free dairy foods like milk, cheese, and yogurt, which does not provide enough calcium, potassium, and vitamin D to meet dietary reference intakes (DRIs). Our objective was to assess the impact of additional servings of dairy foods on the nutrient adequacy of the 1600, 2000, and 2400 kcal HMEP in the 2015 DGA.Methods: Using the same food pattern modeling procedures as the 2015 DGA, we assessed the nutrient composition of three alternative models of the 1600, 2000, and 2400 kcal HMEP. For Model 1, we increased servings of dairy foods (77 kcal/serving). For Model 2, we added one serving of dairy foods and removed one serving of refined grains (85 kcal/serving), and for Model 3 (2400 kcal HMEP only), we added one-half serving of dairy foods and removed one-half serving of refined grains. We then assessed these models for nutrient adequacy and compared them to the Healthy U.S.-Style Eating Pattern and the HMEP.Results: The changes to the HMEP with these models increased the amounts of several nutrients to encourage, including calcium, vitamin D, potassium, vitamin A, phosphorus, riboflavin, vitamin B12, zinc, and magnesium. For instance, Model 1 increased the calcium (by 295 mg), vitamin D (by 59.3 IU), potassium (by 235 mg), vitamin A (by 98 mcg), and phosphorus (by 232 mg) content of the original HMEP, and Model 3 increased the amounts of these nutrients by half of those amounts. Model 2 increased the calcium content by 266 mg, vitamin D by 58 IU, potassium by 202 mg, vitamin A by 88 mcg, and phosphorus by 193 mg. Notably, Models 1 and 2 increased the vitamin D content of the HMEP to about 62% of the DRI (average across all calorie levels) and the potassium content to 78% of the DRI (average across all calorie levels), from 52% and 73%, respectively, in the original HMEP. Most of our models increased the saturated fat (0.5 g in Model 1 and 0.2 g in Model 2) and sodium (202 mg in Model 1 and 101 mg in Model 2) content as well. The amounts of these nutrients to limit remained within the ranges recommended in the 2015 DGA.Conclusions: The addition of a dairy food serving to the 1600, 2000, and 2400 kcal HMEP brings their nutrient profiles closer to the DRIs for several nutrients to encourage, including calcium, vitamin D, and potassium.

Long-chain omega-3 fatty acids, eicosapentaenoic and docosahexaenoic acids (EPA, DHA), are important nutrients, but they do not have a Dietary Reference Intake (DRI) recommendation. This lack of recognition as essential nutrients makes it difficult to set population guidelines for EPA and DHA (like the Dietary Guidelines for Americans). Challenges in proposing EPA and DHA recommendations for the public are mainly determining which health outcomes reflect a €œdeficiency€ for EPA and DHA and defining the EPA and DHA dose recommendation for the general public and at each life stage. The modernization of the DRI process to redefine what €œpreventing deficiency€ means for each nutrient includes allowing the use of chronic health conditions as signs of deficiency, which may be the path by which EPA and DHA will receive a DRI. A circulating biomarker that links EPA and DHA intake with chronic disease risk is the Omega-3 Index, defined as the proportion of EPA and DHA of total erythrocyte fatty acids. An Omega-3 Index of 8% has been shown to be associated with lower risk of cardiovascular disease and an index of less than 4% is associated with higher risk, and these benchmarks could provide a standard to which intake recommendations could be set. There is evidence that around 50% of the US and Canadian populations are less than 4% and efforts to improve omega-3 status and intake in this population may be the most important for population health, especially for pregnant women. The EPA and DHA dose needed to reach an 8% target from 4% is higher than what can reasonably be achieved through diet (1.4-2.2 g/d; daily fish intake); however, aiming to prevent deficiency, or increase the Omega-3 Index above 4% would be more in line with current recommendations (200-300 mg/d; 2 servings of omega-3-rich fish per week).

Chapter 12 - Nutrition Guidelines to Promote and Maintain Health

Nutrition education has the potential not only to increase nutrition knowledge and, potentially, healthy behaviors, among the elderly, but also to reduce the need for health and social services. The nutrition component described herein is part of an overall wellness program that focuses on increasing physical activity and healthy dietary behaviors among participants. We completed a four month nutrition intervention in a group of 33 low income elderly at the Leo Butler Center (LBC) (n=20) and Catholic Presbyterian Apartments (CPA) (n=13) in the fall of 2005 in Baton Rouge, LA. The Social Cognitive Theory (SCT) was used as the theoretical framework. Topics included in the intervention were MyPyramid and Dietary Guidelines for Americans, Food Labels, Nutrition and Aging, and Food Safety. Pre-post testing was used before and after each class to determine changes in knowledge. Food Security status and self-perceived eating habits, nutritional quality of the diet, and nutrition knowledge (pre-and post intervention) were also assessed. The majority of study participants were female (88%), African American (70%), and food secure (78%). Mean age was 66.60±10.93 years; mean weight was 86.36±21.9 kilos; and the mean number of classes attended was 1.88±0.86. For LBC participants, significant increases in knowledge (p<0.001) were shown for all lessons. For CPA participants, significant increases in knowledge were shown for all lessons with the exception of the Food Labels lesson (p=0.02, p=0.01, p<0.001 for MyPyramid and DGA lesson, Nutrition and Aging lesson, and the Food Safety lesson respectively). Significant differences were shown for self-perceived nutritional quality of the diet (p=0.01) and nutrition knowledge (p=0.02) for pre-post intervention results; however, no differences were shown for self-perceived eating habits. Two months after the intervention was completed, a follow up question to determine if there were any dietary changes was included. Respondents reported dietary changes, especially for increases in fruits and vegetables and use of food labels. Therefore, nutrition education in the elderly, especially on MyPyramid and DGA, and Food labels is recommended.

This chapter provides an overview of tools for evaluating dietary intakes of individuals and provides dietary recommendations. Such recommendations have been given by government and other groups for over 100 years (Fig. 2.1). The chapter describes the concepts of dietary status, nutritional status, and the available methods for measuring them. The Dietary Reference Intakes (DRI), the standards for nutrient intakes in the United States and Canada, are described and their multiple uses are discussed. Major us federal guidance related to nutrition is outlined. The Dietary Guidelines for Americans, and recommendations to help guide Americans in altering their current intakes in more healthful directions are summarized. MyPlate (formerly MyPyramid and the Food Guide Pyramid), a guide that provides food-based recommendations based on the Dietary Guidelines for Americans and the DRI, is described. The Healthy Eating Index (HEI), a simple scoring system for of evaluating overall dietary quality including balance, variety, and adequacy of intakes based on the DRI and the Dietary Guidelines is also discussed. Healthy People 2020, a set of national goals for promoting health and preventing disease that involve nutrition, is briefly mentioned. Finally, a new National Nutrition Research Roadmap for Federal human nutrition research 2016–2021 is briefly discussed.

Non-communicable diseases (NCDs) cause a significant global health challenge, with unhealthy diets identified as a major risk factor. Sodium and potassium, which are essential minerals for human health, play important roles in various bodily functions, and an imbalance in their intake can have significant health implications, particularly concerning hypertension and cardiovascular diseases. This review compiles dietary sodium and potassium intake recommendations from prominent global health organizations and compares global guidelines to Japan's Dietary Reference Intake (DRI) guidelines. Sodium and potassium intake guidelines from organizations such as the World Health Organization (WHO), American College of Cardiology (ACC) and American Heart Association (AHA), Dietary Guidelines for Americans (DGA), European Food Safety Authority (EFSA), and DRI for Japanese exhibit variations. Compared to other Asian countries, Japan's historically higher sodium goal aligns with Southeast Asia where traditional preserved foods contribute to high sodium intake. Contrarily, Japan's lower potassium goal contrasts with other countries in Asia promoting a diet rich in fruits and vegetables. The ongoing effort by Japan to align with global recommendations reflects a gradation approach considering social habits. While harmonizing international efforts is essential, appreciating regional diversities is paramount through tailoring guidelines to cultural and dietary habit practices. Implementing context-specific guidelines informed by scientific research can contribute to global efforts in promoting healthy diets and reducing the burden of NCDs. Global guidelines that recommended the daily dietary intake goal for sodium and potassium exhibit variations. These disparities are influenced by diverse factors, including cultural dietary habits, socioeconomic status, health priorities, and available scientific research. Each population should follow the recommendations of their region.

Chapter 13 - Nutrition Guidelines to Maintain Health

We aimed to (a) better understand Americans’ awareness and attitudes towards the Dietary Guidelines for Americans (DGA) from 2005–2015; (b) identify how the public obtains that knowledge, (c) measure their willingness to make healthy changes; and (d) identify important contextual factors that impact knowledge of DGA and nutrition. Quantitative survey data from nationally-representative online panel samples indicate the already low awareness of DGA declined over the last decade. This study fills a gap in the literature and can help guide communication strategies employed by the DGA governing bodies (USDA and HHS), including a consistent brand image incorporating updates over time.

Can children follow a fat-modified diet and have adequate nutrient intakes essential for optimal growth and development?

Food, plant food, and vegetarian diets in the US dietary guidelines: conclusions of an expert panel

Nutrition interventions to address cardiovascular outcomes in chronic kidney disease