Dietary Reference Intake Recommendations Research Articles

Iodine and selenium: Dietary sources and nutritional status of the population of the Kurdistan Region in Northern Iraq

AimThe primary aim of this study was to determine the selenium (Se) and iodine (I) food concentrations and dietary intake of the population living in the Kurdish controlled region of northern Iraq. We also assessed the extent to which iodised salt contributes to dietary iodine intake. MethodologyFoods and samples of salt and drinking water were analysed, including 300 crops samples from 40 local farms. The results, supplemented by food composition data, were used to assess dietary Se and I intake for 410 volunteers using a semi-quantitative food questionnaire. To directly investigate the nutritional status of individuals, urine samples were also collected from participants. ResultsSelenium intake was mainly supplied by protein and cereal sources. Calculated median dietary intake of Se was 62.7 µg d−1 (mean = 66.3 µg d−1) with c. 72 % of participants meeting or exceeding dietary reference intake recommendations for age. Median dietary intake of I, excluding salt consumption, was 94.6 µg d−1 (mean 100.2 µg d−1), increasing to 607.2 µg d−1 when salt (of which >90 % was iodized) was included. Salt intake was estimated to be c.13.5 g d−1 (5400 mg Na d−1) which greatly exceeds WHO recommended intake (< 2000 mg d−1 of Na). Urine iodine concentrations indicated that 98 % of school aged children had excessive iodine intake (≥300 µg L−1) and 80–90 % of all study participants had above average or excessive iodine intake (≥200 µg L−1). ConclusionsPoultry and rice are the main sources of dietary Se to this population but around a third of children receive an inadequate Se intake. Fresh fruit and vegetables are the main sources of dietary I, but consumption of local foods cannot supply adequate I without iodised salt supplementation. Consumption of iodized salt well above recommended amounts is supplying this population with substantial iodine intake. Interventions to reduce salt intake would help to limit excessive iodine intake whilst also reducing cardio-vascular risks from Na consumption.

Dietary Intakes From Ad Libitum Consumption of Canadian Armed Forces Field Rations Compared With Usual Home Dietary Intakes and Military Dietary Reference Intakes.

Diet has an impact on weight status, health, and physical performance. Assessing the usual at-home dietary intakes of military personnel can help ascertain their nutritional status before field training or operations. Preference for foods consumed on a routine basis can also impact the military's preference for and consumption of field rations. Military personnel are limited by the inherent nature of the field rations and availability of calories and food types; and despite previous studies indicating a high acceptability of the field rations, it is unknown whether military personnel self-select the same number of calories when faced with a restricted list of field ration options as they would from their usual foods. Although field rations are intended to be nutritionally sufficient for standard military operations, there are limited data on the ad libitum intake of nutrients of Canadian Armed Forces (CAF) personnel from field rations in comparison to the military dietary reference intake (MDRI) recommendations, which establishes standards intended to meet the nutritional requirements of military personnel on duty. Thus, assessing the adequacy of their usual diets at home and longer-term sustenance on field rations in relation to MDRIs can provide insight on CAF personnel's operational readiness. The objectives of this study were to describe and compare, in a convenience sample of CAF, their ad libitum nutrient intakes from the consumption of self-selected field rations at home with their usual home intakes and to compare both with MDRI recommendations. Eighteen CAF participants weighed and recorded their dietary intake from the ad libitum consumption of field rations at home and their usual at-home diets. Both MDRIs and the Institute of Medicine's dietary reference intake recommendations were used to assess the adequacy of intakes for each individual. Paired Student's t-test or Wilcoxon-matched paired tests were used to compare nutrient intake levels between usual at-home diets and field rations consumed at home. Mean daily energy intakes were similar between ad libitum intakes from field rations (2,688 ± 619 kcal) and usual home diets (2,657 ± 580 kcal), although participants had significantly higher intakes of protein and fat from their home diets and higher intakes of carbohydrates from the field rations (P ≤ 0.05). Participants had less than the recommended intakes of some micronutrients (vitamins A and D, folate, calcium, magnesium, and potassium), from both their home diets and field rations, but adequate intakes of vitamin C and iron. The results of this study showed no difference in energy intake between the consumption of field rations and home diets, with levels consistent with recommendations for individuals with average physical activity levels. The results also demonstrated less than the recommended intakes (in comparison with MDRIs) of some nutrients from both home diets and self-selected consumption of field rations, warranting further research into nutritional adequacy for operational readiness.

Usual Nutrient Intake of Older Adults in the U.S. Is Lower Among SNAP Participants Compared to Income-Eligible Non-Participants

ObjectivesPolicy proposals to limit use of the Supplemental Nutrition Assistance Program (SNAP) and to allow dietary supplement (DS) purchase with SNAP benefits draw attention to knowledge gap of usual nutrient intake and adherence to the Dietary Reference Intake recommendations from foods alone and with DS (total intake) among low-income older adults. To address this gap, the estimated distributions of usual nutrient intake (from foods alone and total) and risk of inadequate intake among U.S. older adults participating in SNAP were compared with income-eligible non-participants. MethodsData from 4,791 older adults (≥60 years) from the 2007–2016 National Health and Nutrition Examination Survey were used in this cross-sectional secondary analysis. DS data from an in-home inventory and dietary data from up to two 24-hour recalls were used to estimate usual nutrient intake distributions (total and from foods alone) and the proportion of the population below the Estimated Average Requirement (EAR) using an adapted National Cancer Institute method. Pairwise t-tests compared SNAP participants and eligible non-participants with significance set at P < 0.05. ResultsSNAP participants had lower usual intake from foods alone compared to eligible non-participants for vitamins B6 (P = 0.046) and E (P = 0.027); the risk of inadequate intake was higher among SNAP participants compared to eligible non-participants for vitamin E (P = 0.0004). Similarly, total usual nutrient intake was lower among SNAP participants compared to eligible non-participants for magnesium (P = 0.019), zinc (P = 0.0003), vitamin C (P = 0.02) and vitamin D (P = 0.0002) and the proportion not meeting the EAR was higher among SNAP participants compared to eligible non-participants for magnesium (P = 0.044). ConclusionsOlder adults participating SNAP had lower usual intake and meet the EAR less compared to eligible non-participants for certain nutrients. The proportion at risk of inadequate intake was lower when all nutrients sources were examined compared to foods alone. Future policies should focus on improving nutrient intake among food assistance participants and their food security. Funding SourcesSupported by University of Kentucky Center for Poverty Research through funding by the U.S. Department of Agriculture, Food and Nutrition Service, Contract Number 12319819C0006.

Assessment of nutritional status, body composition and blood biochemical parameters of patients following sleeve gastrectomy: 6months follow up.

Today, Sleeve gastrectomy (SG) has recently become the most common bariatric procedure among various bariatric surgical procedures due to its advantages. The aim of this study is to investigate nutritional status, body composition and biochemical parameters following SG. This was a prospective study, the subjects were patients who underwent SG at a special obesity clinic in İstanbul, Turkey, between 01.05.2017 and 01.11.2017. The mean body mass index (BMI) of the participants was 42.15±4.84kg/m2 for men and 41.44±4.34kg/m2 for women, preoperatively. Nutritional status, some anthropometric measurements and blood sampling were taken at each visit. Data were collected and analyzed for the present study at the following periods: pre-operation (pre-op), 1 month, 3 months and 6 months after surgery. A total of 47 SG patients (20 men, 27 women) were evaluated. The mean BMI was 30.23±3.56kg/m2 for men and 30.35±4.36kg/m2 for women after 6 months and the amount of excess weight loss (EWL) increased in the 3 months (p<.001). Mean energy, fiber, vitamin A, vitamin C, vitamin B1, niacin, vitamin B12, folate, calcium, magnesium, iron, zinc, phosphorus and iodine were above the Dietary Reference Intake (DRI) recommendations. A significant association was found between protein intake and fat free mass loss in both genders after SG at 6 months (p<.05). Nutrition deficiencies are common for patients after SG. Therefore, it is important to routinely monitor these patients with a professional team.

Characterization of the nutrient profile of processed red raspberries for use in nutrition labeling and promoting healthy food choices.

BACKGROUND:Red raspberries (Rubus idaeus L.) contain varied nutrients and phytochemicals important for healthy aging. Processing berries extends their shelf-life and culinary applications, although information on nutritional content among processed forms are limited.OBJECTIVE:The main objective of the project was to conduct a market basket study to characterize nutrient content and variation in processed red raspberry (RRB) products (i.e., individually quick frozen (IQF), purée, concentrates). Secondary objectives were to provide new data to the USDA nutrient composition database on processed RRB, which is now complete, and to evaluate RRB forms relative to regulatory (US FDA) criteria for food labeling based on Dietary Reference Intake (DRI) recommendations expressed as % Daily Values (DV).METHODS:Processed raspberry product samples were obtained in 2017 from retail outlets, processing plants and distributors, in and outside the USA. Samples were analyzed by pre-qualified laboratories using pre-approved AOAC methods and validated HPLC methods.RESULTS:Nutrient variance in domestic compared to imported product was observed, but on average IQF and purée with seeds are excellent sources of dietary fiber based on FDA criteria of providing ≥20% DV, IQF and purée are good (10–19% DV) sources of copper, thiamin, riboflavin and folate, and all forms were excellent or good sources of vitamin C and manganese. IQF and puréed red raspberries may also be considered a valuable fruit source of lutein/zeaxanthin.CONCLUSIONS:Processed RRB are nutrient rich options for including in a diet for healthy aging.

Changes That Matter to You

The new labeling regulations announced by the US Food and Drug Administration in 2016 that go into effect in 2020 will impact on the label and labeling Daily Values (DVs) of almost all packaged food and beverage labels, and 52% of dietary supplement labels. The article summarizes the important implications of these revisions for health professionals, industry, and consumers. The revised DVs express the levels of nutrients in percentages on the label versus a Dietary Reference Intake standard, and these percentages differ from those on the older labels. The number of vitamin and minerals with DVs on the label has increased from 19 to 27. Recommended amounts and the units in which they are expressed reflect the Dietary Reference Intake recommendations given in recent National Academies reports.

Characterization and Comparison of Nutritional Intake between Preparatory and Competitive Phase of Highly Trained Athletes.

Background and objective: For a high level athlete, it is essential to ensure optimal energy as well as macro- and micro-nutrient and fluid intakes, in order to improve their performance during training and competition. Protein intake should be 1.2–2.1 g/kg/d, whereas the requirements for carbohydrate and fat intakes should be >5g/kg/d and 20–35% of energy, respectively. The micronutrient and fluid intakes in athletes were compared to the Dietary Reference Intake (DRI) and European Food Safety Authority (EFSA) recommendations, respectively. This study aimed to characterize and compare the nutritional habits of athletes at the preparatory and competitive phase, and to test if their nutritional intakes were in accordance with the recommendations. Materials and methods: A total of 276 professional athletes were assessed. To evaluate their nutritional intake, the athletes completed a 7 days food record. Under reporting was defined using a ratio of energy intake to basal metabolic rate (BMR) of 1.1. Body composition was assessed using dual energy X-ray absorptiometry (DXA). Results: Almost half (49%) of the athletes from the final sample reported lower measured intakes of carbohydrates and 27% reported a higher consumption of proteins than what was recommended. In both the preparatory and competitive phases, the micronutrients with a higher mismatch between the actual and recommended intakes were vitamins D and E, magnesium, folate, calcium, and zinc for both sexes, and iron intake for females. A large proportion of athletes reported a lower water intake. Compared to the recommendations, males reported a higher intake of carbohydrates, lipids, vitamins E, calcium, and magnesium (p <0.05) in the competitive phase, while females reported a lower ingestion of water, vitamins A and D, and calcium (p <0.05) in the preparatory phase. Conclusions: Overall, in the preparatory and competitive phases of the season, athletes reported a macro- and micro-nutrient intake below the recommendations, especially in the female athletic population. Dietary intakes in athletes need to be optimized and adjusted to their requirements, according to sex and sport, so as to avoid compromising health and performance.

Lysine Requirements of Healthy Pregnant Women are Higher During Late Stages of Gestation Compared to Early Gestation

Lysine is the first limiting amino acid in cereal proteins and is found mainly in animal-derived products. Current Dietary Reference Intake (DRI) recommendations extrapolate lysine requirements during pregnancy from nonpregnant adult data, and may underestimate true requirements. Our objective is to define a quantitative lysine requirement in healthy pregnant women and to determine whether requirements vary between 2 phases of gestation. Fourteen pregnant women in early (12-19 wk) and 19 women in late (33-39 wk) gestation were studied using the indicator amino acid oxidation technique. Individual lysine intakes (6-84 mg · kg-1 · d-1, deficient to excess) were tested on each study day as a crystalline amino acid mixture based on egg protein composition. Isonitrogenous diets maintained protein intake at 1.5 g · kg-1 · d-1 and calorie intake at 1.7 times resting energy expenditure during each study day. Phenylalanine and tyrosine intakes were held constant across all lysine intakes. Breath and urine samples were collected at baseline and isotopic steady state. Lysine requirements were determined by measuring the oxidation of L-[1-13C]-phenylalanine to 13CO2 (F13CO2). Biphase linear regression crossover analysis was used to determine a breakpoint (which represents the estimated average requirement, EAR) in F13CO2. The EAR for lysine during early gestation was determined to be 36.6 mg · kg-1 · d-1 (R2 = 0.484, upper 95% CI = 46.2 mg · kg-1 · d-1), similar to an earlier adult requirement of 36 mg · kg-1 · d-1. The EAR for lysine during late gestation was determined to be 50.3 mg · kg-1 · d-1 (R2 = 0.664, upper 95% CI = 60.4 mg · kg-1 · d-1), 23% higher than the current pregnancy DRI EAR recommendation of 41 mg · kg-1 · d-1. Our results suggest that lysine requirements are higher during late gestation compared to early gestation, and that current dietary lysine recommendations during late stages of pregnancy may be underestimated. The results have implications for populations consuming cereal-based diets as their primary source of protein. This trial was registered at clinicaltrials.gov as NCT01776931.

Adequacy of Parent-Packed Lunches and Preschooler's Consumption Compared to Dietary Reference Intake Recommendations

abstractBackground: U.S. preschool children consume inadequate amounts of key nutrients. Understanding the contents of lunches packed by parents and consumed by their children can help identify areas of opportunity for the development of healthy food preferences.Objective: To evaluate the nutrient adequacy of lunches packed by parents and consumed by children attending early care and education (ECE) centers.Methods: Baseline data from 607 parent–child dyads in the “Lunch Is in the Bag” cluster-randomized controlled trial in Central Texas were examined. Foods packed by parents and consumed by children in sack lunches were observed at 30 ECE centers on 2 nonconsecutive days. Mean levels of energy, macronutrients, vitamins, and minerals were estimated with covariate-adjusted multilevel regression models that accounted for center-level clustering and repeated within-child measures.Results: Energy (kilocalories) was 602.48 for packed lunches compared to 374.40 for consumed lunches. In packed lunches, percentage of energy as macronutrients for protein (14.8%), carbohydrate (55.9%), and total fat (31.2%) were within the acceptable macronutrient distribution range (AMDR) for the children's ages. Sugar (28.9% of energy) was above the AMDR recommendation. Only a quarter of parents packed 33% or more of the child's dietary reference intake (DRI) for dietary fiber. Over half the parents packed 33% or more of the DRI for vitamin A and calcium, and less than one in 8 packed 33% of the DRI for potassium. Children consistently consumed between 60 and 80% of the nutrients that were packed.Conclusions: Preschool children rely on parents to present them with healthy food choices, but lunches packed by parents for their preschool children do not consistently provide adequate nutrients. These data and the relationships between the dietary quality of packed and consumed lunches can be useful information to guide nutrition behavior change through targeted interventions.

Food intake and the nutritional status of women undergoing chemotherapy.

The objective behind this study was the analysis of food intake and the nutritional status of women with breast cancer (BC) undergoing chemotherapy (CT). The quantitative dietary evaluation was performed in accordance with Dietary Reference Intakes (DRI), whereas the qualitative evaluation was performed through the Brazilian Healthy Eating Index - Revised (BHEI-R).From among the total number of patients (n = 20), 60% (n = 12) presented waist circumference, equal to or higher than 88cm. It was noted that 75% (n = 15) individuals were overweight. The average intake for calcium, copper, iron, dietary fiber, magnesium, potassium, vitamin A, niacin, vitamin B6 and zinc, were found to be below adequate intake levels, while the intake of vitamin C, phosphorus, manganese, sodium and thiamine were all found to be above DRIs recommendations. As for the analysis of the BHEI-R, 80% (n = 16) of the patients presented a "diet that needs modifications", while 20% (n = 4) presented a "healthy diet". Noted from these observations was the presence of a high overweight rate, a discrepancy in the intake of micronutrients and a diet that needed improvements. In this manner, the establishment and use of a nutritional intervention protocol are very important when it comes to the improvement of the diet in patients with BC and who are undergoing CT.

Assessing the nutritional quality of diets of Canadian children and adolescents using the 2014 Health Canada Surveillance Tool Tier System.

BackgroundHealth Canada’s Surveillance Tool (HCST) Tier System was developed in 2014 with the aim of assessing the adherence of dietary intakes with Eating Well with Canada’s Food Guide (EWCFG). HCST uses a Tier system to categorize all foods into one of four Tiers based on thresholds for total fat, saturated fat, sodium, and sugar, with Tier 4 reflecting the unhealthiest and Tier 1 the healthiest foods. This study presents the first application of the HCST to examine (i) the dietary patterns of Canadian children, and (ii) the applicability and relevance of HCST as a measure of diet quality.MethodsData were from the nationally-representative, cross-sectional Canadian Community Health Survey 2.2. A total of 13,749 participants aged 2–18 years who had complete lifestyle and 24-hour dietary recall data were examined.ResultsDietary patterns of Canadian children and adolescents demonstrated a high prevalence of Tier 4 foods within the sub-groups of processed meats and potatoes. On average, 23–31 % of daily calories were derived from “other” foods and beverages not recommended in EWCFG. However, the majority of food choices fell within the Tier 2 and 3 classifications due to lenient criteria used by the HCST for classifying foods. Adherence to the recommendations presented in the HCST was associated with closer compliance to meeting nutrient Dietary Reference Intake recommendations, however it did not relate to reduced obesity as assessed by body mass index (p > 0.05).ConclusionsEWCFG recommendations are currently not being met by most children and adolescents. Future nutrient profiling systems need to incorporate both positive and negative nutrients and an overall score. In addition, a wider range of nutrient thresholds should be considered for HCST to better capture product differences, prevent categorization of most foods as Tiers 2–3 and provide incentives for product reformulation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3038-5) contains supplementary material, which is available to authorized users.

Nutritional Status Prior to Laparoscopic Sleeve Gastrectomy Surgery.

Two main causes for nutrient deficiencies following bariatric surgery (BS) are pre-operative deficiencies and favoring foods with high-energy density and poor micronutrient content. The aims of this study were to evaluate nutritional status and gender differences and the prevalence of nutritional deficiencies among candidates for laparoscopic sleeve gastrectomy (LSG) surgery. A cross-sectional analysis of pre-surgery data collected as part of a randomized clinical trial on 100 morbidly obese patients with non-alcoholic fatty liver disease (NAFLD) admitted to LSG surgery at Assuta Medical Center between February 2014 and January 2015. Anthropometrics, food intake, and fasting blood tests were evaluated during the baseline visit. One-hundred patients completed the pre-operative measurements (60% female) with a mean age of 41.9 ± 9.8years and a mean BMI of 42.3 ± 4.7kg/m(2). Pre-operatively, deficiencies for iron, ferritin, folic acid, vitamin B1, vitamin B12, vitamin D, and hemoglobin were 6, 1, 1, 6, 0, 22, and 6%, respectively. Pre-surgery, mean energy, protein, fat, and carbohydrate intake were 2710.7 ± 1275.7kcal/day, 114.2 ± 48.5, 110.6 ± 54.5, and 321.6 ± 176.1gr/day, respectively. The intakes for iron, calcium, folic acid, vitamin B12, and vitamin B1 were below the Dietary Reference Intake (DRI) recommendations for 46, 48, 58, 14, and 34% of the study population, respectively. We found a low prevalence of nutritional deficiencies pre-operatively except for vitamin D. Most micronutrient intake did not reach the DRI recommendations, despite high-caloric and macronutrient intake indicating a poor dietary quality.

Web Alert

Sportscience www.sportsci.org Description: This is a peer-reviewed journal and web site that is maintained by Will Hopkins, PhD, a professor of sport and exercise science in Auckland, New Zealand. The web site’s greatest contribution is the wealth of resources for those engaging in sport-related research. Articles and spreadsheets explain and provide examples of many aspects of research design including assigning subjects in controlled trials, statistical analysis tools and their applicability, sample size estimation, assessment of validity, and design of meta-analyses to name a few. Utilization of the articles and spreadsheets requires some prior training in research due to the level at which they are written. Cost: Free Chronic Osteoarthritis Management Initiative http://www.usbji.org/programs/coami Description: The U.S. Bone and Joint Initiative is an action network tasked with improving the care of people with musculoskeletal conditions. One of its offshoot initiatives convened in 2012 that deals specifically with osteoarthritis (OA) is the Chronic Osteoarthritis Management Initiative. Its aims are to improve early diagnosis, develop tools that promote patient self-management and engagement, support prevention and coordinated care of OA, and develop an OA-specific research agenda. This web site is the public face of this initiative. Cost: Free The Dietary Supplement Label Database www.dsld.nlm.nih.gov/dsld/ Description: The Dietary Supplement Label Database (DSLD) is a joint effort of the National Institute of Health and the National Library of Medicine. The DSLD web site contains the full label contents of all dietary supplements marketed in the United States. Although it is initially being developed for research purposes, it serves as an easily navigable resource for consumers and providers as well those who may be wishing to investigate the contents of a specific supplement. The web-based databases are searchable and also are organized for browsing based on specific ingredients, the product name, or the manufacturer. Where applicable, it also compares ingredient levels within a product with the current dietary reference intake recommendations. Cost: Free U.S. Anti-Doping Agency www.usada.org Description: The web site of the U.S. Anti-Doping Agency serves as a one-stop resource for athletes, trainers, and physicians with questions about supplement use and medication use in sports. In conjunction with the World Anti-Doping Agency (WADA-AMA.org), they maintain a unified Prohibited List and an International Standard for Laboratories to clarify what entails fair completion and just testing practices. The status of all medications and supplements can be searched including whether they are banned in competition, out of competition, or both. In cases where prohibited medications are prescribed for legitimate medical diagnoses, USADA.org walks individuals through the application of therapeutic use exemptions. USADA is a signatory to the revised World Anti-Doping code, which took effect on January 1, 2015, which is an effort to streamline antidoping efforts around the globe. Cost: Free Run Sweet www.runsweet.com Description: This is a web site built by individuals with diabetes who are participating in sports. It is written specifically for those with diabetes who have questions about diabetes and athletic participation. The medical content is edited by an endocrinologist in the UK who specializes in diabetic care. In addition to general information on diabetes, there is information on initiating sport participation, what happens to glucose and hormone levels with exercise, and tips on how to safely exercise and effectively manage one’s diabetes during athletic participation. For providers looking for thorough and thoughtful educational resources for their diabetic athletes, this is an excellent web site to recommend. Cost: Free

Misreporting of Dietary Intake Affects Estimated Nutrient Intakes in Low-Income Spanish-Speaking Women

Misreporting of dietary intake affects the validity of data collected and conclusions drawn in studies exploring diet and health outcomes. One consequence of misreporting is biological implausibility. Little is known regarding how accounting for biological implausibility of reported intake affects nutrient intake estimates in Hispanics, a rapidly growing demographic in the United States. Our study explores the effect of accounting for plausibility on nutrient intake estimates in a sample of Mexican-American women in northern California in 2008. Nutrient intakes are compared with Dietary Reference Intake recommendations, and intakes of Mexican-American women in a national survey are presented as a reference. Eighty-two women provided three 24-hour recalls. Reported energy intakes were classified as biologically plausible or implausible using the reported energy intakes to total energy expenditure cutoff of <0.76 or >1.24, with low-active physical activity levels used to estimate total energy expenditure. Differences in the means of nutrient intakes between implausible (n=36) and plausible (n=46) reporters of energy intake were examined by bivariate linear regression. Estimated energy, protein, cholesterol, dietary fiber, and vitamin E intakes were significantly higher in plausible reporters than implausible. There was a significant difference between the proportions of plausible vs implausible reporters meeting recommendations for several nutrients, with a larger proportion of plausible reporters meeting recommendations. Further research related to misreporting in Hispanic populations is warranted to explore the causes and effects of misreporting in studies measuring dietary intake, as well as actions to be taken to prevent or account for this issue.

Mineral content and adequacy of oral hospital diets offered to chronic kidney disease pre-dialysis patients

Summary Background & aims The diet for patients with Chronic Kidney Disease (CKD) has important clinical impact on the disease progression. This study determined the contents of Ca, P, K, Na, Mg, Fe, Mn, Cu, Zn and Se in an oral hospital diet and a Oral Food Complement (OFC), prepared for CKD patients, with the adequacy quantified with respect to nutritional recommendations. Methods Samples of the diet were collected in a Brazilian public hospital, with mineral determination by ICP-OES. The Dietary Reference Intake and specific nutritional recommendations for CKD patients were used to assess the nutritional adequacy. Results About 14.3% of the diets produced for CKD patients were analyzed. The levels of P, K, Mn and Na were over the recommendation, with Na exceeding the Upper Level. Inadequacy of Ca and Se were observed for all groups and ages. Inadequate values of iron were found for adult women. The combination of OFC with the diet was sufficient to provide adequate values of Fe, however, did not increase Ca and Se contents to adequate levels, and added unnecessary quantities of P, K and Na. Conclusion With the exception of K and P the diets exhibited insufficient mineral contents and toxic levels of Na. Diet menus and OFC compositions need to be changed to meet the nutritional recommendations and support the clinical assistance of CKD patients and also contribute to the nutritional education of this group.

Consumo de energia e macronutrientes no lanche escolar de adolescentes de São Luís, Maranhão, Brasil

Objetivo:Métodos:Trata-se de um estudo transversal realizado com 200 adolescentes de 15 a 17 anos de duas escolas, sendo uma pública e outra privada. Realizaram-se recordatórios alimentares específicos do lanche escolar referentes aos últimos três dias em que os participantes estiveram na escola. As contribuições calóricas de carboidratos, lipídeos e proteínas foram analisadas com base nas Dietary Reference Intakes(DRI). A análise estatística foi realizada pelo software Stata 10.0. Para as comparações entre alunos de escola pública e privada e entre os sexos, foram utilizados os testes t de Student e do χ2. O nível de significância foi fixado em 5%.Resultados:O consumo de lanche escolar foi relatado por 69,5% dos adolescentes. A maioria adquiria esse lanche nas cantinas das escolas: privada (76,0%) e pública (51,0%). Adolescentes de escolas públicas tiveram maior consumo de energia (338,7 versus 286,3 kcal; p=0,043) e carboidratos (52,5 versus 39,3 g; p=0,006). A adequação dos macronutrientes apareceu em metade da amostra: carboidratos (43,9%), proteínas (43,2%) e lipídeos (49,6%). Alunos de escola pública apresentaram maior adequação de carboidratos (p&lt;0,001) e de lipídeos (p&lt;0,001). Meninos apresentaram maior adequação da contribuição calórica de proteínas (55,6 versus 32,9%; p=0,007), enquanto as meninas tiveram maior adequação de carboidratos (52,6 versus 33,3%; p=0,005) e de lipídeos (61,8 versus 34,9%; p=0,006).Conclusão: A inadequação dos macronutrientes mostrou-se elevada no grupo, o que sugere a baixa qualidade do lanche consumido por esses adolescentes.

Micronutrient intakes among U.S. children: understanding variability in different age and gender groupings in NHANES 2007‐2010 (1024.13)

The Institute of Medicine (IOM) presents Dietary Reference Intake recommendations according to specified age, gender and life‐stage groups, including 1‐3 years and 4‐8 years for children, and 9‐13 years and 14‐18 years separately for males and females. Researchers, however, often present dietary intake data using different groupings. This project used data from the U.S. National Health and Nutrition Examination Survey (NHANES) 2007‐2010 to evaluate the variability in reported intakes of micronutrients in children using various age and gender cut‐offs. The IOM groupings were used, but since dietary intake data from NHANES are not available for 1‐year‐olds, a grouping for 2‐3 year olds was used instead. In addition, intake data for 4‐6 year olds, 7‐9 year olds, 10‐12 year olds, 13‐18 year olds and 4‐12 year olds were also evaluated for both genders combined and for males and females separately. The National Cancer Institute method was used to adjust the NHANES dietary intake data to provide more reliable estimates of habitual consumption (NCI, 2012). Variability of micronutrient intakes and percentage of the population below recommended intakes within each age and gender category were evaluated using z‐scores. Finding the most relevant age groups to present dietary intake data is important because the type and amount of foods eaten change throughout growth and development. Age categories should reflect these changes to best understand dietary patterns.Grant Funding Source: Nestle Research Center

Obesity coexists with malnutrition? Adequacy of food consumption by severely obese patients to dietary reference intake recommendations.

To assess the adequacy of food intake in severely obese patients and describe their main nutritional deficiencies on the basis of Dietary Reference Intakes (DRIs). Patients on a waiting list for bariatric surgery were sequentially recruited from March 2010 to November 2011. All subjects underwent nutritional status assessment (anthropometry, dietary recall and semi-structured interview), socioeconomic evaluation (Brazilian Association of Research Companies criteria) and laboratory testing (glucose/hormone/lipid panel). A total of 77 patients were assessed, 50 of whom (76.6%) were female. Mean age was 44.48 ± 12.55 years. The most common comorbidities were hypertension (72.4%), binge eating disorder (47.4%), type 2 diabetes mellitus (32.9%), sleep apnea (30.3%) and dyslipidemia (18.4%). Macronutrient intake was largely adequate, in view of the high calorie intake. However, some micronutrient deficiencies were present. Only 19.5% of patients had an adequate intake of potassium, 26.0% of calcium, and 66.2% of iron. All subjects consumed more than the minimum recommended intake of sodium, with 98.7% reaching the upper limit. Bcomplex vitamin intake was satisfactory (adequate in >80% of subjects), but lipid-soluble vitamin (A, D, E) intake often fell short of the RDI. The diet of severely obese patients is unbalanced, with high calorie intake paralleled by insufficient micronutrient intake. When these patients are assessed and managed, qualitative dietary changes should be considered in addition to routine caloric restriction.

Anthropometry, Nutritional Status, and Dietary Intake in Pediatric Patients with Osteogenesis Imperfecta

Objective: The aim of the present study was to assess anthropometric measurements, nutritional status, dietary intake, and body fat percentage of pediatric patients with osteogenesis imperfecta (OI). Method: A cross-sectional study evaluated 63 OI patients from 0 to 19 years of age. We analyzed anthropometric measurements, mobility, bisphosphonate treatment, body fat percentage (by dual-energy x-ray absorptiometry [DEXA] and sum of skinfold thickness), nutritional status, and dietary intake (using World Health Organization [WHO] and dietary reference intake recommendations for macronutrients and calcium intake, respectively). Participants’ energy requirements were calculated using both kilocalorie per centimeter measurements and WHO methods. Results: Patients with different types of OI had different anthropometric measurements (p < 0.05), where OI type III had severely limited stature and poor mobility. Nutritional status was correlated with measurements of arm circumference and body fat. We also found a strong correlation between the 2 methods used to calculate percentage of body fat (r = 0.803). OI type III had a higher percentage of energy intake. We observed that 75% of subjects had a calcium intake below 95% of recommended daily value and there was an inverse correlation between age and calcium intake. Conclusions: This study showed that stature was compromised mainly in OI type III. Skinfold thickness and arm circumference correlated to nutritional status and also to body fat calculated by DEXA. Daily calcium intake was below the recommended levels in pediatric patients with OI. These findings are important for the management of OI subjects.

Association of Nutritional Status with Quality of Life in Breast Cancer Survivors

Nutritional status and dietary intake play a significant role in the prognosis of breast cancer and may modify the progression of disease. The aim of this study was to determine the influence of nutritional status on the quality of life of Iranian breast cancer survivors. Cross-sectional data were collected for 100 Iranian breast cancer survivors, aged 32 to 61 years, attending the oncology outpatient clinic at Golestan Hospital, Ahvaz, Iran. Nutritional status of subjects was assessed by anthropometric measurements, Patient-Generated Subjective Global Assessment (PG-SGA) and three non-consecutive 24-hour diet recalls. The European Organization of Research and Treatment of Cancer Quality of Life form (EORTC QLQ-C30) was used to assess quality of life. Ninety-four percent of the survivors were well-nourished, 6% were moderately malnourished or suspected of being malnourished while none were severely malnourished. Prevalence of overweight and obesity was 86%. Overall, participants had an inadequate intake of vitamin D, E, iron and magnesium according to dietary reference intake (DRI) recommendations. Survivors with better nutritional status had better functioning scales and experienced fewer clinical symptoms. It appears important to provide educational and nutritional screening programs to improve cancer survivor quality of life.