Adequate Dietary Intake Research Articles

Investigation of the effect of dietary intake of omega-3 polyunsaturated fatty acids on trauma-induced white matter injury with quantitative diffusion MRI in mice.

Previous studies suggest that long‐term supplementation and dietary intake of omega‐3 polyunsaturated fatty acids (PUFAs) may have neuroprotective effects following brain injury. The objective of this study was to investigate potential neuroprotective effects of omega‐3 PUFAs on white matter following closed‐head trauma. The closed‐head injury model of engineered rotational acceleration (CHIMERA) produces a reproducible injury in the optic tract and brachium of the superior colliculus in mice. Damage is detectable using diffusion tensor imaging (DTI) metrics, particularly fractional anisotropy (FA), with sensitivity comparable to histology. We acquired in vivo (n = 38) and ex vivo (n = 41) DTI data in mice divided into sham and CHIMERA groups with two dietary groups: one deficient in omega‐3 PUFAs and one adequate in omega‐3 PUFAs. We examined injury effects (reduction in FA) and neuroprotection (FA reduction modulated by diet) in the optic tract and brachium. We verified that diet did not affect FA in sham animals. In injured animals, we found significantly reduced FA in the optic tract and brachium (~10% reduction, p < 0.001), and Bayes factor analysis showed strong evidence to reject the null hypothesis. However, Bayes factor analysis showed substantial evidence to accept the null hypothesis of no diet‐related FA differences in injured animals in the in vivo and ex vivo samples. Our results indicate no neuroprotective effect from adequate dietary omega‐3 PUFA intake on white matter damage following traumatic brain injury. Since damage from CHIMERA mainly affects white matter, our results do not necessarily contradict previous findings showing omega‐3 PUFA‐mediated neuroprotection in gray matter.

Survey of Arsenic Contents in Shell-Medicament Used as Chinese Medicine

The shells of mollusks such as Concha Haliotidis (Shijueming), Concha Arcae (Walengzi), Concha Ostreae (Muli) and Pearl are used as ingredients in certain Chinese medicines. Such shells can accumulate heavy metals. Because arsenic is toxic to humans, an investigation of arsenic content in these medicaments is necessary to protect the health of humans. The shells of mollusks were digested with diversified acids, and then surveyed by hydride generation atomic absorption spectrometry. The arsenic content was 4.45, 3.41, 1.93 and 5.28 ppm in Pearl, Muli, Shijueming, and Walengzi respectively. All were below the announced levels of safe and adequate daily dietary intake for humans.

Effects of Prolonged Whey Protein Supplementation and Resistance Training on Biomarkers of Vitamin B12 Status: A 1-Year Randomized Intervention in Healthy Older Adults (the CALM Study).

We investigated the effect of long-term whey supplementation on biomarkers of B12 status in healthy older adults subjected to different schemes of supplements and exercise. The total study population examined at baseline consisted of 167 healthy older adults (age ≥ 65 year) who were randomized to 1-y intervention with two daily supplements of (1) whey protein (3.1 µg B12/day) (WHEY-ALL), (2) collagen (1.3 µg B12/day) (COLL), or (3) maltodextrin (0.3 µg B12/day) (CARB). WHEY-ALL was comprised of three groups, who performed heavy resistance training (HRTW), light resistance training (LITW), or no training (WHEY). Dietary intake was assessed through 3-d dietary records. For the longitudinal part of the study, we included only the participants (n = 110), who met the criteria of ≥ 50% compliance to the nutritional intervention and ≥ 66% and ≥ 75% compliance to the heavy and light training, respectively. Fasting blood samples collected at baseline and 12 months and non-fasting samples collected at 6 and 18 months were examined for methylmalonic acid, B12 and holotranscobalamin. At baseline, the study population (n = 167) had an overall adequate dietary B12 intake of median (range) 5.3 (0.7–65) µg/day and median B12 biomarker values within reference intervals. The whey intervention (WHEY-ALL) caused an increase in B12 (P < 0.0001) and holotranscobalamin (P < 0.0001). In addition, methylmalonic acid decreased in the LITW group (P = 0.04). No change in B12 biomarkers was observed during the intervention with collagen or carbohydrate, and the training schedules induced no changes. In conclusion, longer-term daily whey intake increased plasma B12 and holotranscobalamin in older individuals. No effect of intervention with collagen or carbohydrate or different training regimes was observed. Interestingly, the biomarkers of B12 status appeared to be affected by fasting vs. non-fasting conditions during sample collection.

Micronutrient-rich dietary intake is associated with a reduction in the effects of particulate matter on blood pressure among electronic waste recyclers at Agbogbloshie, Ghana

BackgroundInformal recycling of electronic waste (e-waste) releases particulate matter (PM) into the ambient air. Human exposure to PM has been reported to induce adverse effects on cardiovascular health. However, the impact of PM on the cardiovascular health of e-waste recyclers in Ghana has not been studied. Although intake of micronutrient-rich diet is known to modify these PM-induced adverse health effects, no data are available on the relationship between micronutrient status of e-waste recyclers and the reported high-level exposure to PM. We therefore investigated whether the intake of micronutrient-rich diets ameliorates the adverse effects of ambient exposure to PM2.5 on blood pressure (BP).MethodsThis study was conducted among e-waste and non-e-waste recyclers from March 2017 to October 2018. Dietary micronutrient (Fe, Ca, Mg, Se, Zn, and Cu) intake was assessed using a 2-day 24-h recall. Breathing zone PM2.5 was measured with a real-time monitor. Cardiovascular indices such as systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) were measured using a sphygmomanometer. Ordinary least-squares regression models were used to estimate the joint effects of ambient exposure to PM2.5 and dietary micronutrient intake on cardiovascular health outcomes.ResultsFe was consumed in adequate quantities, while Ca, Se, Zn, Mg, and Cu were inadequately consumed among e-waste and non-e-waste recyclers. Dietary Ca, and Fe intake was associated with reduced SBP and PP of e-waste recyclers. Although PM2.5 levels were higher in e-waste recyclers, exposures in the control group also exceeded the WHO 24-h guideline value (25 μg/m3). Exposure to 1 μg/m3 of PM2.5 was associated with an increased heart rate (HR) among e-waste recyclers. Dietary Fe intake was associated with a reduction in systolic blood pressure levels of e-waste recyclers after PM exposure.ConclusionsConsistent adequate dietary Fe intake was associated with reduced effects of PM2.5 on SBP of e-waste recyclers overtime. Nonetheless, given that all other micronutrients are necessary in ameliorating the adverse effects of PM on cardiovascular health, nutrition-related policy dialogues are required. Such initiatives would help educate informal e-waste recyclers and the general population on specific nutrients of concern and their impact on the exposure to ambient air pollutants.

Characterization and modulation of brain lipids content of rainbow trout fed with 100% plant based diet rich in omega-3 long chain polyunsaturated fatty acids DHA and EPA

Brain functions are known to be mainly modulated by adequate dietary intake. Inadequate intake as can be an excess or significant deficiency affect cognitive processes, behavior, neuroendocrine functions and synaptic plasticity with protective or harmful effects on neuronal physiology. Lipids, in particular, ω-6 and ω-3 long chain polyunsaturated fatty acids (LC-PUFAs) play structural roles and govern the different functions of the brain. Hence, the goal of this study was to characterize the whole brain fatty acid composition (precursors, enzymatic and non-enzymatic oxidation metabolites) of fish model of rainbow trout fed with three experimental plant-based diet containing distinct levels of eicosapentaenoic acid (EPA, 20:5 ω-3) and docosahexaenoic acid (DHA, 22:6 ω-3) (0% for low, 15.7% for medium and 33.4% for high, total fatty acid content) during nine weeks. Trout fed with the diet devoid of DHA and EPA showed reduced brain content of total ω-3 LC-PUFAs, with diminution of EPA and DHA. Selected enzymatic (cyclooxygenases and lipoxygenases) oxidation metabolites of arachidonic acid (AA, 20:4 ω-6) decrease in medium and high ω-3 LC-PUFAs diets. On the contrary, total selected enzymatic oxidation metabolites of DHA and EPA increased in high ω-3 LC-PUFAs diet. Total selected non-enzymatic oxidation metabolites of DHA (not detected for EPA) increased in medium and high ω-3 LC-PUFAs diets. In conclusion, this work revealed for the first time in fish model the presence of some selected enzymatic and non-enzymatic oxidation metabolites in brain and the modulation of brain lipid content by dietary DHA and EPA levels.

Calcium supplementation for improving bone density in lactating women: a systematic review and meta-analysis of randomized controlled trials

Clinical trials evaluating the effect of calcium supplementation on bone loss in lactating women have been small, with inconsistent results. We aimed to determine the effect of calcium supplementation on bone mineral density (BMD) in lactating women. An electronic search of databases was conducted from inception to January 2020. Two authors screened studies, extracted data, and assessed the risk of bias of eligible studies. Percentage change in BMD was pooled using random-effects models and reported as weighted mean differences (WMDs) with 95% CIs. Risk of bias was assessed using the Cochrane risk of bias tool. Five randomized controlled trials including 567 lactating women were included. All had a high risk of bias. Mean baseline calcium intake ranged from 562 to 1333 mg/d. Compared with control groups (placebo/no intervention), calcium supplementation (600/1000 mg/d) had no significant effect on BMD at the lumbar spine (WMD: 0.74%; 95% CI: -0.10%, 1.59%; I2=47%; 95% CI: 0%, 81%; n=527 from 5 trials) or the forearm (WMD: 0.53%; 95% CI: -0.35%, 1.42%; I2=55%; 95% CI: 0%, 85%; n=415 from 4 trials). BMD at other sites was assessed in single trials: calcium supplementation had a small to moderate effect on total-hip BMD (WMD: 3.3%; 95% CI: 1.5%, 5.1%) but no effect on total body or femoral neck BMD. Overall, the meta-analysis indicates that calcium supplementation does not provide clinically important benefits for BMD in lactating women. However, there was adequate dietary intake before supplementation in some studies, and others did not measure baseline calcium intake. Advising lactating women to meet the current recommended calcium intakes (with supplementation if dietary intake is low) is warranted unless new high-certainty evidence to the contrary from robust clinical trials becomes available. More research needs to be done in larger samples of women from diverse ethnic and racial groups.This systematic review was registered at www.crd.york.ac.uk/prospero as CRD42015022092.

Examination Of Low Energy Availability And Sleep In High-intensity Functional Exercise Program Athletes

Low energy availability (LEA) affects the body’s physiological systems, which can negatively affect an athlete’s performance and recovery. Athletes that participate in high-intensity functional exercise may not have adequate dietary intake to match energy needs or obtain optimal amount of sleep to recover fully. PURPOSE: To examine the low energy availability (LEA) and sleep among male and female recreational athletes who engage in high-intensity functional exercise programs. METHODS: Thirty adults (age: 31.2 ± 8.1; males: n = 12, 176.9 ± 6.2 cm, 89.5 ± 15.1 kg; females: 164.7 ± 7.1 cm, 69.9 ± 11.1 kg) participated in a larger cross-sectional study. Participants completed a demographic survey, Pittsburgh Sleep Quality Scale, a 7-day online dietary and exercise log. Participants were measured for height, weight, DXA scan (BMD), and RMR through indirect calorimetry (MedGem). ANOVAs examined differences between gender and energy needs, and Chi-squared analysis examined differences between gender and risk for LEA and Poor Sleep. RESULTS: Significant differences were found between gender and RMR (males: 2296.7±400.3 kg; females: 1761.7±341.6 kg; P=0.001), EI (males: 2027.5±694.5 kg; females: 1568.9±461.1 kg; P=0.038) and EEE (males: 357.8±60.3 kg; females: 279.3±44.4 kg; P≤0.01). No significant differences were found between gender and LEA (males: 24.8.7±12.2 kg; females: 25.0±8.9 kg). Overall risk for LEA was 66.7% (n = 20); however independently LEA was 50% (n=6) for males and 77.8% (n=14) for females. Overall, 63.3% (n=19) recreational athletes report poor sleep. No significant differences were found across gender and poor sleep, independently poor sleep for males was 50% (n=6) and females 72.2% (n=13). No significant differences were found between gender, poor sleep, and LEA. Of those at risk for LEA (n=20), 60% (n=12) also had reported poor sleep. CONCLUSIONS: Recreational athletes were at risk for both LEA and poor sleep, with a majority at risk for both. A combination of LEA and poor sleep can lead to poor performance and recovery from high-intensity exercises. Therefore, education to recreational athletes on the importance of dietary intake to match energy needs and encouragement for positive sleeping habits is imperative to optimize physiological recovery.

Dietary Potassium Downregulates Angiotensin-I Converting Enzyme, Renin, and Angiotensin Converting Enzyme 2.

BackgroundThe importance of dietary potassium in health and disease has been underestimated compared with that placed on dietary sodium. Larger effort has been made on reduction of sodium intake and less on the adequate dietary potassium intake, although natural food contains much more potassium than sodium. The benefits of a potassium-rich diet are known, however, the mechanism by which it exerts its preventive action, remains to be elucidated. With the hypothesis that dietary potassium reduces renal vasoconstrictor components of the renin-angiotensin system in the long-term, we studied the effect of high potassium diet on angiotensin-I converting enzyme, renin, and angiotensin converting enzyme 2.MethodsSprague Dawley male rats on a normal sodium diet received normal potassium (0.9%, NK) or high potassium diet (3%, HK) for 4 weeks. Urine was collected in metabolic cages for electrolytes and urinary volume measurement. Renal tissue was used to analyze angiotensin-I converting enzyme, renin, and angiotensin converting enzyme 2 expression. Protein abundance analysis was done by Western blot; gene expression by mRNA levels by RT-qPCR. Renal distribution of angiotensin-I converting enzyme and renin was done by immunohistochemistry and morphometric analysis in coded samples.ResultsHigh potassium diet (4 weeks) reduced the levels of renin, angiotensin-I converting enzyme, and angiotensin converting enzyme 2. Angiotensin-I converting enzyme was located in the brush border of proximal tubules and with HK diet decreased the immunostaining intensity (P < 0.05), decreased the mRNA (P < 0.01) and the protein levels (P < 0.01). Renin localization was restricted to granular cells of the afferent arteriole and HK diet decreased the number of renin positive cells (P < 0.01) and renin mRNA levels (P < 0.01). High potassium intake decreased angiotensin converting enzyme 2 gene expression and protein levels (P < 0.01).No morphological abnormalities were observed in renal tissue during high potassium diet.The reduced expression of angiotensin-I converting enzyme, renin, and angiotensin converting enzyme 2 during potassium supplementation suggest that high dietary potassium intake could modulate these vasoactive enzymes and this effects can contribute to the preventive and antihypertensive effect of potassium.

Postoperative Dietary Quality is Poor after Major Musculoskeletal Trauma

Abstract Objectives Musculoskeletal trauma often leads to prolonged functional deficits. Adequate dietary intake and supplementation improves clinical outcomes after surgical fixation of hip fracture in older adults. The role of post-operative nutrition after acute fracture has not been elucidated. Our objective was to describe dietary deficiencies after operative fixation of acute fracture in young adults. Methods An observational, cohort study identified patients aged 18–55 years presenting to a Level 1 trauma center with pelvic or extremity fracture indicated for operative fixation. Dietary intake was measured using Automated Self- Administered 24-hour dietary recall (ASA24®) in weeks 1, 2, and 4 postoperatively. Individual macro- and micro-nutrients for each subject were summarized using arithmetic means. Inadequate nutritional intake was determined using Dietary Reference Intake (DRI) values reported by the Institute of Medicine. The Healthy Eating Index 2015 (HEI-2015) score was calculated based on ASA24® data as described by the USDA. Results Most subjects were healthy preoperatively, 98% had ≤1 comorbidity. Eighty-four % of injures were to the lower extremities, and 59% were isolated. The majority of subjects (78%) discharged home. An average of 3.9 surveys were filled out per subject. Dietary intake overall was inadequate; 72% did not meet calorie needs. Protein intake was inadequate in 66%. All subjects did not meet DRIs for fiber, vitamin E, or potassium. More than 50% did not meet DRI for calcium, iron, magnesium, folate, vitamins C, A, or K. Added sugar and saturated fat intake exceeded recommendations in 38% and 41% of subjects respectively. Intake of beneficial foods such as whole grains and vegetables were inadequate in 100% of subjects; fruit intake was inadequate in 88%. The mean HEI-2015 score was 44.7 (±11.4 SD) across all time points. Conclusions In a population of previously healthy, young adults with major musculoskeletal trauma, dietary quality was poor compared to the average for the US population, 44.7 vs 59 HEI-2015. Diet analysis revealed a concerning lack of vegetables, whole grains, multiple micronutrients, and total calories. This data provides goals for adequate nutritional supplementation after musculoskeletal trauma. Funding Sources No payments were received to conduct this research study.

Effect on Myogenesis and Anti-Inflammation of Mealworm (Tenebrio Molitor) Larvae Protein Hydrolysate

Abstract Objectives Sarcopenia, a loss of skeletal muscle mass and functions, becomes prevalent in older populations. Adequate dietary protein intake is one of the most effective ways to improve sarcopenia. The mealworm is an edible insect that comprises high levels of proteins and micro-nutrients. It could be used a potential protein source for enhancing muscle growth. Also, protein hydrolysate is easily digested and absorbed by the human body with greater functional properties. In investigating the prevention of sarcopenia with mealworm larvae, we optimize the hydrolysis condition of mealworm larvae protein isolate (MPI) and the effect of myogenesis and anti-inflammation of mealworm larvae protein hydrolysate (MPH). Methods The optimization of MPH by alcalase and flavorzyme was investigated based on the amount of available α-amino acids (L-Leucine) by TNBS assay and the distribution patterns of molecular weight by SDS-PAGE. ABTS radical scavenging capacity, expression of myostatin (MSTN), MSTN promoter activity, and anti-inflammatory induced by palmitate and LPS were examined. Results The hydrolysate prepared for 12 hours by adding flavourzyme after hydrolysis of the MPI with alcalase for 12 hrs under 1% substrate and 1% enzyme/substrate at 55˚C, pH 8 showed the highest available α-amino acid (22.09 mg/g) and had the largest amount of low-molecular peptides at 10 kDa or less. Antioxidant capacity was also the highest (97.8%) among the hydrolysates prepared under different conditions. In the MSTN level which negatively regulate muscle growth, MPH (0.28 MSTN/GAPDH) was lower than MPI (0.38 MSTN/GAPDH). Also, in the MSTN promoter activity, MPI (16.94 Luc/β-gal) was higher than the control while MPH (9.99 Luc/β-gal) was lower activity than the control (12.47 Luc/β-gal). MPI and MPH induced lower expression levels of IL-6, TNF-a, and IL-1b cytokines. Conclusions MPH had better capacity in myogenesis compared to MPI, particularly hydrolyzed by flavourzyme after hydrolysis of the MPI with alcalase. Also, the MPH decreased proinflammatory cytokines which increase proteolysis and muscle atrophy. These results demonstrate that MPH could be used as a source for preventing sarcopenia. Funding Sources This study was supported in part by the National Research Foundation of Korea.

Association of Infant and Child Feeding Index with Undernutrition in Children Aged 6-59 Months: A Cross-Sectional Study in the Maldives.

Adequate dietary intake is critically important for child growth and development. This study aimed to analyze the prevalence of undernutrition and its association with infant and child feeding index (ICFI). This cross-sectional study was conducted among children (younger than5 years) and their mothers from Lhaviyani Atoll, Maldives. The data were obtained by interviewing the children's mothers via pretested questionnaires. Infant and child feeding index scores were calculated from the dietary information. Weight-for-age z-scores (WAZ), length/height-for-age z-scores (LAZ/HAZ), and weight-for-length/height z-scores were calculated from anthropometric data taken according to the WHO criterion. Linear regression tests were used to find the association of nutritional status with ICFI scores. A total of 800 children and their mothers participated in this study. The prevalence of underweight, stunting, and wasting was 24.6%, 32.4%, and 16.3%, respectively. The mean ICFI scores (13.0) of children aged 6-8 months were better than those of children in other age-groups. In food groups, the intake of fish was higher among the respondents, whereas the consumption of vegetables and fruits was lower. Infant and child feeding index scores were significantly associated (P < 0.05) with WAZ and LAZ/HAZ after adjustment for confounders. Overall, the findings showed that Maldivian children consumed the limited number of food items that resulted in an inadequate intake of nutrients which further resulted in the high prevalence of malnutrition.

Determinants of Stunting Among Children Age 6-59 Months, Siraro District, West Arsi Zone, Oromia Region, Ethiopia

Background: High level child stunting, Height for age measurement less than negative two standard deviation is 38%. It has significant effect on schooling, productivity, physical fitness, human resources and Loss of National economy. Children ages 6-59month are the most affected groups due to child hood infections, maternal health condition, in adequate dietary intake and poor child caring practice. However, there is insufficient information on determinant factors contributing for stunting. Therefore, identifying determinants of stunting among children aged 6-59 month would help to set priorities for action and to the design of stunting reduction plan at a grass roots level. Objectives: To identify determinants of stunting among Children aged 6-59 months in Siraro District. Methods: The unmatched Facility based case control study design was conducted in randomly selected 5 health facilities of Siraro District from August 01, 2019 to October 30, 2019. From 357 study subjects which 119 are cases and 238 controls were chosen by using anthropometric measurement based on the median of WHO 2006 reference population . Anthro-plus software was used to identify the anthropometric measurements of the child and a structured questionnaire which was primarily developed in English and translated to Afan Oromo was used for data collection. The collected data were entered using Epi-deta version3.1 and exported to SPSS version 20 for analysis. Logistic regression was used to determine the association between dependent and independent variables. In bi-variable analysis co-variates with P-value of less than 0.25 was included in multivariable analysis. The final model was interpreted using AOR with 95%; CI at P-value of less than 0.05. Results: Age started supplementary feeding at 6 months with (AOR=2.54 95% CI ((1.01-6.42)), Childs mother has no Antenatal visit (AOR=2.39(95%; (1.15-4.97)), Children with poor Food Consumption Score were (AOR=3.48; 95 %;( 1.82-6.65)), Children’s with poor protein rich food Frequency Score were 3.74 times (AOR=3.74; 95%; 2.10-6.75)) were significantly associated with stunting. Conclusion; Factors like Age started supplementary feeding at less than six month, mother has no antenatal visit, poor food consumption score, poor protein rich food frequency score could be used to set priorities for action and design of stunting reduction. Therefore, zonal health department and Siraro Woreda health office should promote the importance of supplementary feeding at age of 6 months. Strengthening antenatal care service at a grass root level and promote antenatal visit of mothers. Enhance an appropriate complementary feeding practice and providing sufficient energy and protein reach food is important. Keywords: Stunting; Malnutrion; Determinants; among under five children DOI: 10.7176/JHMN/74-01 Publication date: May 31 st 2020

Why Multiples of 21? Why does Selenoprotein P Contain Multiple Selenocysteine Residues?

Background:In animals, the 21st amino acid selenocysteine is incorporated into a restricted subset of proteins by recoding of a UGA stop codon. This recoding requires a distinctive selenocysteine insertion sequence in selenoprotein encoding mRNAs, trans-acting factors and in most cases, adequate dietary intake of selenium. With one exception, selenoproteins contain a single selenocysteine, which is incorporated with low translational efficiency. The exception is selenoprotein P, which in some species is predicted to contain as many as 132 selenocysteines and which is considered to play roles in selenium transport and storage.Objective:This study aimed to develop comparative physiological and evolutionary perspectives on the function(s) of selenoprotein P.Method:The review of the literature on the roles of selenoprotein P in diverse animals.Results:Selenoprotein P contains multiple selenocysteines, making it energetically costly to produce. Furthermore, it is often associated with detrimental effects to the animals that produce it. Possible benefits that outweigh these costs include the general storage and transport of selenium; the transport of both toxic and useful metal ions; and specific functions in reproduction and in the nervous system.Conclusion:A probable reconciliation of the negative effects of producing Selenoprotein P is its benefit in terms of promoting reproductive success.

The South Asian Health Foundation (UK) guidelines for managing diabetes during Ramadan

BackgroundFasting in the holy month of Ramadan is among the five pillars of Islam and is considered as a religious obligation by the Muslim population. People with diabetes observing the practice of fasts are at a higher risk of complications such as hypoglycaemia, hyperglycaemia and ketoacidosis due to changes in eating patterns and circadian rhythms. With the objective of mitigating these complications, the South Asian Health Foundation (UK) has developed the present guidelines based on robust evidence derived from epidemiological studies and clinical trials. MethodsWe have highlighted the role of pre-Ramadan risk stratification and counselling by healthcare professionals with emphasis on the need for advice on adequate dietary and fluid intake, blood glucose monitoring and awareness of when to break the fast. ResultsWe reviewed the current literature and have given clinically-relevant recommendations on lifestyle modifications and glucose-lowering therapies such as metformin, sulphonylureas, dipeptidyl peptidase-4 inhibitors, sodium glucose co-transporter-2 inhibitors, thiazolidinediones, glucagon-like peptide-1 receptor agonists and insulin. ConclusionsAn individualised patient-centric treatment plan is essential to not only achieve optimal glycaemic outcomes but also enable people with diabetes to observe a risk-free month of fasting during Ramadan.

Orthorexia nervosa: examining the Eating Habits Questionnaire's reliability and validity, and its links to dietary adequacy among adult women.

There has been increasing interest in identifying individuals with pathological healthy eating behaviours, or orthorexia nervosa (ON). This study aimed to investigate the validity (construct- and criterion-related) and reliability (internal consistency) of the Eating Habits Questionnaire (EHQ) as a measure of ON. A secondary aim was to examine how the EHQ would predict a distinct feature of ON, adequate dietary intake. Cross-sectional online questionnaire incorporating existing measures of ON and dietary intake. Participants were recruited online via social media and a university's research webpage. Women (n 286) ranging in age from 17 to 73 years. Exploratory factor analysis established that the EHQ represented four ON dimensions (Healthy Eating Cognitions, Dietary Restriction, Diet Superiority and Social Impairment), inconsistent with the scale's original three dimensions (Problems, Knowledge and Feelings). Cronbach's α coefficients ranged from 0·72 to 0·80 for the four subscales and was 0·89 for the total EHQ scale. Criterion-related validity revealed a significant moderate to strong correlation (r = -0·54, P < 0·001) between the EHQ and ORTO-10 (a ten-item version of ORTO-15). The EHQ, particularly the EHQ-Diet superiority subscale, was found to be predictive of better, as opposed to, poorer dietary adequacy. Findings suggest that improvements still need to be made to the EHQ for it to be a valid and reliable measure of ON. Ideally, new assessment tools based on established diagnostic criteria are needed to advance our understanding of ON.

Assessment of knowledge, attitudes and practice towards Vitamin D among university students in Pakistan

BackgroundPakistan has one of the highest reported incidence of vitamin D deficiency in studies conducted worldwide. However, there has been very limited exploration of vitamin D related knowledge, attitudes and practices among healthy youth in Pakistan.MethodsA cross-sectional survey was conducted among youth (aged > 16 years) from two engineering universities in Pakistan. Participants were asked questions on their concern about vitamin D levels, testing, and supplementation practices. Knowledge was examined using questions about food sources, health benefits and factors affecting vitamin D production within the human body. Of the 900 eligible students invited to participate, 505 (56%) completed the questionnaire and were included in the analysis.ResultsOnly 9% participants were able to identify the correct food sources of vitamin D, 33% were aware of the bone health benefits (bone health and calcium absorption) of vitamin D and 36% identified sunlight exposure as a factor influencing vitamin D production. Knowledge about food sources and health benefits of vitamin D was not associated with gender and individuals concern about their levels. Those tested and taking supplements were more likely to identify bone related health benefits and factors affecting vitamin D production. Forty percent male and 52% female students expressed concern that their vitamin D levels were too low. However, 72% participants reported that they had never been tested for vitamin D levels. Use of supplements was significantly higher among female students (F = 52% vs M = 37%; P = 0.003). Those who had been tested for vitamin D deficiency were more likely to take supplements.ConclusionDespite being identified as a high-risk population, knowledge about vitamin D was limited among university students. Interventions are needed to increase awareness about the importance of vitamin D for health, including the need for exposure to sunlight and adequate dietary intake of vitamin D. Our study provides much needed baseline evidence for making health-policy recommendations for this vulnerable population group.

Dentition, nutritional status and adequacy of dietary intake in treatment naïve head and neck cancer patients

ObjectivesTo examine the relationship of reduced numbers of occluding teeth and dietary intake (DI), nutrition impact symptoms (NIS), and weight loss (WL) in head and neck cancer (HNC) patients. MethodsAs a part of the standard of care, treatment-naïve HNC patients (n = 104) completed dental evaluation (number of teeth, total anterior/posterior occlusal teeth, Eichner Index (EI) classification), WL, DI questionnaire and HNC Symptom Checklist©. Descriptive statistics (Kruskal-Wallis, Fisher-exact, χ2 tests) and (uni-) multi-variable logistic regression. ResultsOverall, 42, 45 and 13% of patients were in EI-class A, B and C with a median of 8, 3, and 0 total posterior occlusal teeth. EI-class B/C patients were older, more likely to have impaired DI (OR = 3.88; 95%CI:1.63–9.26; P = 0.002) and reported interference with DI by 11 NIS (p < 0.05). DI was, however, reported as unimpaired in 77, 49 and 39% of patients in EI-class A, B and C, respectively. The subset of EI-class B/C patients with impaired DI, had more NIS interference with DI (P < 0.05; difficulty chewing, pain, early satiety, lack of energy); EI-class C patients additionally had dry mouth, thick saliva and dysphagia (P < 0.05). In logistic regression, EI-classes B/C patients with reduced (vs unimpaired) DI were more likely to have ≥5% WL (OR = 10.1; 95%CI:2.0–50.0), higher NIS interference (range OR 4.3–10.7). ConclusionsMore than half of these HNC patients had reduced numbers of occlusal teeth or were edentulous. EI-class B/C patients did not necessarily have impaired DI, however the combination of EI-class B/C and a constellation of NIS, associated with reduced DI. Clinical significanceTreatment naïve head and neck cancer (HNC) patients with reduced occlusal and masticatory performance (Eichner Index B/C) and reduced dietary intake are at high risk for weight loss. Identifying HNC patients at risk may improve their oral health, dietary intake and reduce their risk of weight loss.

A131 MALNUTRITION FOLLOWING IMPLEMENTATION OF A STRICT LOW FODMAP DIET FOR IBS

Abstract Background Low fermentable oligosaccharides, disaccharides, monosaccharides and polysaccharides, polyols (FODMAP) diet is an elimination diet recommended for the symptom management of irritable bowel syndrome (IBS). It involves reducing the amount of unabsorbed and fermentable carbohydrates in attempt to decrease osmotic overload and gas production. This diet may be deficient in calcium and carbohydrates and alter the gut microbiota, however, its long-term nutritional implications are unknown. Thus, the 2019 CAG Guidelines for management of IBS suggest its short-term use with dietician supervision. To our knowledge, no previous cases of malnutrition secondary to a low FODMAP diet have been reported. Aims We report of case of severe weight loss and laboratory evidence of malnutrition following a low FODMAP diet in a patient with IBS. Methods Data was obtained by chart review, patient interview and review of relevant literature. Results A 40-year-old otherwise healthy female presented to the outpatient gastroenterology clinic for assessment of IBS in fall of 2018. At that time, she had been moderately restricting FODMAPs for several months to reduce abdominal pain and bloating. After her initial clinic visit, she followed a strict low FODMAP diet for 1 month, followed by slow and gradual re-introduction of high FODMAP containing foods. This was self-implemented without the supervision of a dietician, using on-line resources. From fall of 2018 to early 2019, she lost 12 percent of her body weight secondary to dietary restriction. While there was some improvement in bloating and pain, she developed significant fatigue. Blood work prior to implementation of low FODMAPs diet was normal, including INR of 1.2, albumin of 45 g/L, neutrophil count 2.2 x 10E9/L, and alkaline phosphatase 31 U/L (30–110 U/L). In spring of 2019, 5 months after starting a low FODMAP diet, her INR was elevated at 1.4, neutrophils low at 1.6 x 10^9/L, alkaline phosphatase low at 32 U/L (35 U/L – 120 U/L), with normal albumin of 45 g/L. After consulting a hematology specialist, she was advised to resume adequate dietary intake. She slowly returned to her baseline diet, but excluded lactose, beans, fruit, eggs, nuts and oats. While she restored her body weight by Fall 2019, her gut symptoms returned, although had improved overall. Her lab work showed normal neutrophils of 2.7 x 10^9/L, INR 1.3, with unchanged albumin at 45g/L. Conclusions While these are indirect markers of nutritional adequacy, the timeline and associated weight loss are highly suggestive of dietary inadequacy secondary to FODMAP restriction. Serum albumin remained normal as FODMAP restriction does not affect dietary protein intake. This case exemplifies the danger of initiating extreme dietary restriction in self-management manner and stresses the need of dietician supervision of such a restrictive diet. Funding Agencies None

Anthropometric and dietary differences among Mexican older adults with and without adequate body image perception

ObjectiveWe compared anthropometric and dietary indicators between groups of older Mexican adults with accurate or inaccurate body image perception (BIP). MethodsA cross-sectional study was carried out with 201 older adults (age ≥ 60 years) of both sexes who completed the Stunkard scale for BIP, which consists of nine silhouettes with an equivalent of body mass index (BMI) status, then, the accuracy with their real BMI was calculated and reported energy and macronutrient intake through a 24-h dietary recall directed by different geriatric centers in Colima, Mexico. Basic anthropometry and bioelectrical impedance analyses were performed. ResultsWe found that 71.1% of the older adults had inaccurate BIP; 66.6% underestimated their body mass and 4.5% overestimated their body mass, the other 28.9% hat accurate BIP. The overall concordance between the real nutritional status and BIP was poor (kappa coefficient = 0.03). The inaccurate BIP group had a significantly higher mean body mass index, body fat percentage, muscle mass, and arm and calf circumference compared to the accurate BIP group (p < .001); only 4.3% of the older adults who were overweight and 6.2% who were obese had an accurate BIP. Regarding dietary consumption, we found significant differences only in energy and carbohydrate intake between the two groups. Finally, excess body fat was associated with an inaccurate BIP (OR: 2.8, 95% CI: 1.5–5.5). ConclusionIn older adults, an inaccurate BIP is generally associated with high anthropometric values and less than adequate dietary intake.

Comparison of three classes of Marginal Risk Set Model\xa0in predicting infant mortality among newborn babies at Kigali\xa0University\xa0Teaching Hospital, Rwanda, 2016

BackgroundThe Infant Mortality Rate (IMR) in Sub-Saharan Africa (SSA) remains the highest relatively to the rest of the world. In the past decade, the policy on reducing infant mortality in SSA was reinforced and both infant mortality and parental death decreased critically for some countries of SSA. The analysis of risk to death or attracting chronic disease may be done for helping medical practitioners and decision makers and for better preventing the infant mortality.MethodsThis study uses popular statistical methods of re-sampling and one selected model of multiple events analysis for measuring the survival outcomes for the infants born in 2016 at Kigali University Teaching Hospital (KUTH) in Rwanda, a country of SSA, amidst maternal and child’s socio-economic and clinical covariates. Dataset comprises the newborns with correct information on the covariates of interest. The Bootstrap Marginal Risk Set Model (BMRSM) and Jackknife Marginal Risk Set Model (JMRSM) for the available maternal and child’s socio-economic and clinical covariates were conducted and then compared to the outcome with Marginal Risk Set Model (MRSM). That was for measuring stability of the MRSM.ResultsThe 2117 newborns had the correct information on all the covariates, 82 babies died along the study time, 69 stillborn babies were observed while 1966 were censored. Both BMRSM JMRSM and MRSM displayed the close results for significant covariates. The BMRSM displayed in some instance, relatively higher standard errors for non-significant covariates and this emphasized their insignificance in MRSM. The models revealed that female babies survive better than male babies. The risk is higher for babies whose parents are under 20 years old parents as compared to other parents’ age groups, the risk decreases as the APGAR increases, is lower for underweight babies than babies with normal weight and overweight and is lower for babies with normal circumference of head as compared to those with relatively small head.ConclusionThe results of JMRSM were closer to MRSM than that of BMRSM. Newborns of mothers aged less than 20 years were at relatively higher risk of dying than those who their mothers were aged 20 years and above. Being abnormal in weight and head increased the risk of infant mortality. Avoidance of teenage pregnancy and provision of clinical care including an adequate dietary intake during pregnancy would reduce the IMR in Kigali.