Consumption Of Fortified Foods Research Articles

The effect of motivation type on intake and nutritional status of vitamin B12, omega-3 fatty acids, iron and nutrition knowledge in individuals following a vegan diet

The fundamental principle of veganism is to avoid all possible animal exploitation and therefore, animal ethics has always been a primary motivator. Nowadays, the environment and health are also common motivators. Omission of all animal products leads to dietary exclusion of vitamin B12, limited intake of omega-3 fatty acids, specifically EPA and DHA, and intake of low bioavailable iron sources1. Obtaining the knowledge to appropriately plan and replace nutrients through food or supplementation is key to avoiding deficiencies and subsequent consequences. This study aimed to determine the effect of motivation for being vegan on intake of key nutrients and nutritional knowledge. This cross-sectional, observational study recruited participants, who had followed a vegan diet for minimum 2 years. Demographics and nutrition knowledge were obtained from questionnaires. Motivation type was determined using the validated vegetarian eating motives inventory (VEMI) – participants scored the importance of animal ethic, environment and health. Intakes of vitamin B12 and iron, were collected using a 4-day food diary and assessed against Estimated Average Requirement (EAR). Blood samples were taken to determine status of vitamin B12, haemoglobin, serum ferritin, and omega-3 index. Omega-3 index score ≤4 indicates increased risk of coronary heart disease. Animal ethics was the greatest motivator to become vegan, with 83.5% of participants scoring it as very important, compared to 71.7% of people stating the environment, and 53.3% stating health. No association was found between all motivation types and intake of vitamin B12 and iron, nor omega-3 index. Mean vitamin B12 intake (supplements excluded) of 2.11ug/day ± 3.43 exceeded the EAR of 2.0ug/day for both men and women, however intakes ranged between 0.00 and 37.63ug/day. Mean intake of iron (18.77mg/day) exceeded the EAR for both men and women. Overall mean omega-3 index was 3.16%. Both men (162.24g/L) and women (151.44g/L) had adequate mean Hb serum concentrations. Mean serum ferritin was within normal range for both men (64.86ug/L ± 43.48) and women (32.55ug/L ± 26.04). Overall mean serum vitamin B12 was within normal range (316.54pmol/L ± 146.18), however a large range was observed from 72.00pmol/L to 1,015pmol/L. Males and females had similar knowledge, with only one question regarding fibre content in cornflakes found to be significantly different (P = 0.012). Knowledge was varied e.g., 100% of participants could identify that pasta was a carbohydrate source, yet could not identify which fats are most important to reduce. Mean vitamin B12 intake exceeding EAR and normal status despite limited vegan sources, indicates high consumption of high bioavailable fortified foods, and supplementation. Iron status shows large consumption of iron rich foods to overcome bioavailability issues, reflected by adequate iron intake, after increasing EAR by 80% to meet recommendations. The mean omega-3 index shows a low cardioprotective omega-3 fatty acid intake.

Attitude, awareness and recommendations regarding fortified food usage amongst Health Care Professionals of Punjab.

Introduction: Fortification is the practice of deliberately increasing the content of one or more micronutrients i.e., vitamins and minerals in a food or condiment to improve the nutritional quality of the food supply and provide a public health benefit with minimal risk to health. As well as increasing the nutritional content of staple foods, the addition of micronutrients can help to restore the micronutrient content lost during processing.
 Objectives: To assess attitude about fortified foods, awareness regarding usage of fortified food and related recommendations amongst health care professionals of Punjab.
 Place and duration of study: All districts of Punjab (Total of 36 districts). The study was carried out from 1st September 2019 to 1st March 2020.
 Materials and methods: A descriptive cross sectional study in which total 360 MBBS doctors, nurses, mid wives, lady health care workers from 36 districts of Punjab were taken as sample. A questionnaire highlighting attitude and awareness regarding fortified food consumption amongst health professionals and their recommendations for selection of vehicle and fortificants were used as data collection tool. Data was entered in SPSS version 26.0. For demonstration of attitude related to fortified food, preferred fortificants along with their vehicle and recommended vehicles for fortification, bar chats were used. For quantitative variables frequency and percentages were applied.
 Results: Supplements were preferred over consumption of fortified foods by most of the health care professionals i.e. MBBS doctors, nurses and lady health workers. Whereas, midwives were of the opinion that fortified food should be used rather than supplements. Furthermore, probiotics, calcium, iodine, iron, omega three, vitamin A and vitamin C were least known fortificants amongst health care professionals.
 Conclusion: Food fortification is one of the best tools to prevent micro and macronutrients related diseases and illnesses. Most of the health professionals were only aware about fortification of calcium, iodine, vitamin D and iron and their most preferred vehicle for fortification were oil/ghee, juices, bread and water. It is recommended to opt mandatory fortification approaches to be launched legally and strict check and balance regarding their implementation to minimize the disease burden and to improve the immunity of our population. 
 Keywords: Attitude, Awareness, Fortified food, Fortificants, Fortification vehicles, Health Care Professionals.

Micronutrient intake of children in Ghana and Benin: Estimated contribution of diet and nutrition programs.

We estimated how micronutrient needs of young children, aged 6-24 months were covered by the standard (traditional) diets in Ghana and Benin, and the contributions of partial breastfeeding and national nutrition programs aimed at improving micronutrient status to overall micronutrient intakes. Estimates of micronutrient intake from standard diets were based on previous surveys, using the food composition table of West Africa (INFOOD). Recommended micronutrient intakes were based on World Health Organization recommendations. Children were grouped in threeage groups (6-8, 9-12, and 13-24 months) to capture the changing dynamics of the complementary feeding period. As expected, from 6 months of age onwards, breastmilk didn't cover the micronutrient needs. The standard diets contributed only minimal to micronutrient intakes of children ranging from 0% to 37% of recommended intakes for Ca, Fe, Zn, vitamin A, vitamin Dand iodine depending on the micronutrient considered. The contribution of mass (bio)-fortification programs to the coverage of micronutrient needs varied widely, depending on the staple food considered and the country, but overall did not allow to fill the gap in micronutrient needs of children except for vitamin A in some contexts. In contrast, consumption of voluntary fortified complementary food, especially formulated for the needs in this age groups, contributed substantially to overall micronutrient intake and could fill the gap for several micronutrients. The development of young child-targeted programs including micronutrient-dense foods, associated with interventions to increase the diet diversity and meal frequency, could significantly improve micronutrients intakes of children in both Ghana and Benin.

Conversion of calcium-l-methylfolate and (6S)-5-methyltetrahydrofolic acid glucosamine salt into dietary folate equivalents.

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver a scientific opinion on the conversion of calcium‐l‐methylfolate and (6S)‐5‐methyltetrahydrofolic acid glucosamine salt (collectively called 5‐MTHF hereafter) into dietary folate equivalents (DFE). Following a systematic review, the conclusions of the opinion are based on one intervention study in adults for intakes < 400 μg/day and three intervention studies in adults for intakes ≥ 400 μg/day. At intakes below 400 μg/day, folic acid (FA) is assumed to be linearly related to responses of biomarkers of intake and status and is an appropriate comparator for deriving a DFE conversion factor for 5‐MTHF. It is proposed to use the same factor as for folic acid for conversion of 5‐MTHF into DFE for intakes < 400 μg/day. As such intake levels are unlikely to be exceeded through fortified food consumption, the conversion factor of 1.7 relative to natural food folate (NF) could be applied to 5‐MTHF added to foods and to food supplements providing < 400 μg/day. At 400 μg/day, 5‐MTHF was found to be more bioavailable than folic acid and a conversion factor of 2 is proposed for this intake level and for higher intakes. The derived DFE equations are DFE = NF + 1.7 × FA + 1.7 × 5‐MTHF for fortified foods and food supplements providing intakes < 400 μg/day; and DFE = NF + 1.7 × FA + 2.0 × 5‐MTHF for food supplements providing intakes ≥ 400 μg/day. Although this assessment applies to calcium‐L‐methylfolate and 5‐MTHF glucosamine salt, it is considered that the influence of the cation on bioavailability is likely to be within the margin of error of the proposed DFE equations. Therefore, the proposed equations can also be applied to 5‐MTHF associated with other cations.

Dietary Supplement Use in Relation to Socio-Demographic and Lifestyle Factors, including Adherence to Mediterranean-Style Diet in University Students.

The study aimed to examine socio-demographic and lifestyle determinants, including diet quality, of dietary supplement (DS) use among 2545 students who attended public universities in Warsaw. The data was collected using a self-administered health and lifestyle questionnaire and a 5-day dietary record method. Diet quality was assessed using a Mediterranean Diet Score. To determine the covariates of DS use, multivariate-adjusted logistic regression models with an estimation of odds ratios (ORs) and 95% confidence intervals (95% CIs) were used. The results showed that 41% of participants were DS users. The following predictors of DS use were identified: gender (male vs. female; OR:0.62, 95% CI:0.50–0.79), physical activity (high vs. low; OR:1.79, 95% CI:1.45–2.20), BMI (≥25 vs. 18.5–24.9 kg/m2; OR:0.77, 95% CI:0.61–0.98), cigarette smoking (yes vs. no; OR:0.67, 95% CI:0.52–0.86), and presence of chronic diseases (yes vs. no; OR:2.37, 95% CI:1.89–2.98). Moreover, higher nutritional knowledge, special diet usage, eating more meals/day, and fortified food consumption were determinants of DS use. Adherence to the Mediterranean-style diet was positively associated with DS use, a 1-score increment was associated with a 10% (p-trend = 0.011) higher probability of DS usage. Given that the use of vitamins and/or minerals is common among university students and their users are characterized by eating a higher quality diet, investigating the contribution of DS in overall dietary nutrient intake warrants further study.

Contribution of voluntary fortified foods to micronutrient intake in The Netherlands

PurposeIn the Netherlands, voluntary fortification of foods with micronutrients is allowed under strict regulations. This study investigates the impact of voluntary food fortification practices in the Netherlands on the frequency and type of fortified food consumption and on the micronutrient intakes of the Dutch population.MethodsData of the Dutch National Food Consumption Survey (2012–2016; N = 4314; 1–79 year) and the Dutch Food Composition Database (NEVO version 2016) was used. To determine if voluntary fortified foods could be classified as healthy foods, criteria of the Dutch Wheel of Five were used. Habitual intakes of users and non-users of voluntary food fortification were calculated using Statistical Program to Assess Dietary Exposure (SPADE) and compared.ResultsWithin the Dutch population, 75% could be classified as user of voluntary fortified foods. Consumed voluntary fortified foods were mostly within food groups ‘Fats and Oils’, ‘Non-alcoholic Beverages’ and ‘Dairy products and Substitutes’ and fell mostly outside the Wheel of Five. Voluntary foods contributed between 9 and 78% to total micronutrient intake of users. Users had up to 64% higher habitual micronutrient intakes, compared to non-users. These higher intakes resulted into lower risks on inadequate intakes, and did not contribute to increased risks of excessive intakes.ConclusionAlthough voluntary fortified foods increased micronutrient intakes, most of these foods cannot be classified as healthy foods. Future studies should study the association between higher micronutrient intakes and (potential) excessive intakes of e.g. saturated fat and sugar to better understand the role of voluntary fortified foods in a healthy food pattern.

Prevalence of Vitamin D Deficiency among University Students in Uşak, Turkey

Vitamin D deficiency is now recognized as a pandemic with implications for multi-organ systems including bone health and immunological processes. Low levels have been associated with several chronic and infectious diseases. The aim of the study was to evaluate the prevalence of vitamin D deficiency among university students in Usak, Turkey. This cross-sectional study included 100 (44 male and 56 female) university students between January 2020 to February 2020. Demographics, medical history, sunlight exposure, dietary vitamin D intake, body mass index of each individual were recorded in face-to-face interviews. Subjects with known metabolic conditions affecting vitamin D metabolism were excluded. Vitamin D nutritional status was assessed as deficient if 25(OH)D levels were &lt;20ng/mL, insufficient if between 20 and 30 ng/mL, sufficient if ≥30 ng/mL, while &lt;10ng/mL was considered as severe. The mean age for all students was 20.18±1.77(18-30) years. The mean serum 25(OH)D level was 11.60±9.81 among all students (12.22 ± 5.40 ng/mL in males, 11.11±12.24 ng/ml in females). 91 students (91%) were assessed as vitamin D deficient (92.86% among female, 88.64% among male, P &gt;.05). Prevalence of vitamin D insufficiency and deficiency among male students were 11.36 and 88.64%, respectively. Vitamin D deficiency was highly prevalent among medical students included in this study and its deficiency especially among female students is alarmingly prevalent. Absence of vitamin D fortified foods in Turkish market is shortcoming. Therefore, preventive strategies parallel to regular vitamin D fortified food consumption is seriously recommended.

Iron and folic acid: natural, enriched, fortified, and supplements. Analysis of food sources in the Autonomous City of Buenos Aires.

Fortification and supplementation are two strategies for micronutrient deficiency prevention. The objective of this study was to describe the source of iron and folic acid intake throughout the life cycle in the population of the Autonomous City of Buenos Aires. Analysis of the information collected in the First Survey on Nutritional Food Intake of the Autonomous City of Buenos Aires (2011), which had a probability cluster sampling design. Consumption was assessed by means of a 24-hour recall. Iron and folic acid intake was estimated and categorized into natural content, enriched wheat flour, milk from the Maternal and Child Plan, fortified foods, and supplements. Out of the 5369 studied individuals, practically all got iron and folic acid from natural contents (58 % and 29 % of intake, respectively). More than 90 % consumed enriched wheat flour, which provided 28 % of iron and 54 % of folic acid. Fortified food consumption and intake varied greatly. Milk intake from the Maternal and Child Plan was small, even in specific groups. Intake from supplements was low, except in children < 2 years old (30 % consumed iron supplements, which accounted for 38 % of iron). In addition to natural intake from foods, enriched wheat flour accounted for a major source of folic acid and iron in this population; intake from fortified foods and supplements varied by age group.

Impact of Fortified Ultra-Processed Foods on Risk of Anemia: A New Perspective for Pediatric Nutrition

Abstract Objectives Poor diet quality is a major risk factor for the development of anemia. An increased consumption of fortified ultra-processed food (UPF) among children presents a new contributor to micronutrient intake, one that could potentially improve anemia biomarkers despite having a concomitantly low diet quality. Our objective was to investigate the impact of fortified UPF consumption on the prevalence of anemia and diet quality among children from low-income families in Brazil. Methods A cross-sectional analyses from a randomized field trial of children at 3 years of age (n = 432) from Porto Alegre, Brazil. Capillary blood samples were taken to measure hemoglobin concentration (Hb) and used to determine anemia status. Dietary data was assessed using two multiple-pass 24-h recalls and the consumption of UPF was classified according to the NOVA system. Results UPF account for 42.6% of total energy intake. Children in the highest tertile of UPF consumption had significantly lower risk of anemia (Hb &amp;lt; 110 g/L) compared to those in the lowest tertile (tertile 3 vs. tertile 1; OR 0.56 95% CI 0.39 to 0.82). Similarly, a 10% increase in the consumption of UPF was associated with a 22% lower risk of anemia (95% CI 0.64 to 0.94). Conversely, consumption of UPF was negatively associated with consumption of unprocessed/minimally processed foods. Finally, as the contribution of UPF to total energy intake increased, the intake of added sugars, total fats, and sodium increased, whereas the intake of proteins, fiber, and calcium decreased. Conclusions The consumption of fortified UPF was associated with a lower risk of anemia and a poor diet quality in children from a low-income community in Brazil. The co-existence of normal Hb with poor diet quality suggests the need for a more nuanced assessment of dietary patterns in low-income settings to best address this paradoxical situation as the prevalence of the double burden of disease continues to increase throughout the world. Funding Sources Coordination for the Improvement of Higher Education Personnel (CAPES).

The role of fortified foods and nutritional supplements in the diets of older Irish adults

AbstractLow intakes and suboptimal status of vitamin D, riboflavin, vitamin B12, folate and calcium have been reported in older adults across Europe. Dietary strategies to improve micronutrient intakes and status could include food fortification (mandatory or voluntary) and/or the use of nutritional supplements. This study aims to examine the impact of fortified food consumption and nutritional supplement use on nutrient intakes and nutritional status of vitamin D, riboflavin, vitamin B12, dietary folate equivalents (DFE) and calcium in older Irish adults.Analyses were based on the National Adult Nutrition Survey (NANS) (2008–2010). A 4 day semi-weighed food record was used to collect food and beverage intake data (including nutritional supplement use) from a nationally representative sample of 1500 adults (226 older adults (≥ 65y)). Blood samples (n 1126 (n 145 ≥ 65y)) were collected, processed and analysed using standard operating procedures. Nutrient intakes were estimated using WISP© based on UK and Irish food composition data. Fortified foods were identified as those that had one or more micronutrients added in the ingredient list and a nutritional supplement was defined as a supplement containing vitamins and/or minerals (i.e. excludes herbal/non-nutritional supplements). A fortified food consumer or nutritional supplement user was defined as a participant who consumed a fortified food or took a nutritional supplement at any time over the 4-day recording period. Usual intakes of micronutrients were calculated via the NCI-method using SAS© Enterprise Guide and analyses of biomarker data were carried out using SPSS©.The consumption of fortified foods and/or use of nutritional supplements increased mean intakes of vitamin D (3.6 to 6.9μg/d), riboflavin (1.6 to 2.3mg/d), vitamin B12 (4.5 to 6.0μg/d), DFE (228 to 408μg/d) and calcium (784 to 947mg/d) in older Irish adults and reduced the prevalence of inadequate intakes of these micronutrients by up to 40%. Furthermore, consumers of fortified foods and/or nutritional supplements had improved biomarker status and reduced prevalence of low/deficient status for vitamin D (62 vs 16%), riboflavin (65 vs 11%), vitamin B12 (8 vs 0%) and folate (serum folate:18 vs 0%; red blood cell folate: 0% across all groups) when compared to non-consumers.This study has shown that fortified foods and/or nutritional supplements represent an opportunity to improve intakes and status of key micronutrients in older adults. The data presented in this study will serve to inform the development and implementation of updated dietary recommendations for older adults in Ireland.

Consumers’ perception of vitamin D and fortified foods

PurposeAs natural dietary sources of vitamin D are not consumed in sufficient quantities, fortified foods could play a role in maintaining vitamin D sufficiency. With public consultation, an integral part of designing acceptable fortification strategies, the purpose of this paper is to understand public awareness and perception of vitamin D fortified foods.Design/methodology/approachA mixed-methods approach was taken with two focus groups and 109 surveys conducted using a non-probability sample from North-East England. Thematic analysis of focus group data identified six themes, with factor and cluster analysis identifying seven factors and four clusters, respectively, which highlighted differences in vitamin D knowledge and fortified food perceptions.FindingsDespite identifying sunlight as the main vitamin D source (91 per cent), participants were less aware of the main dietary source (33 per cent), and few could state fortified products (51 per cent). Although attitudes towards fortification were generally favourable (63 per cent agreeing that selected products should be fortified), nearly half (43 per cent) were unsure if more products should be made available. Results suggest that more natural products to complement existing market offerings would be most preferred. Factor and cluster analysis results identified awareness of health benefits and/or dietary sources as essential to have favourable attitudes towards fortified products.Originality/valueThis research adds to the limited literature regarding consumer attitudes towards fortified foods. It highlights a need to improve public awareness and labelling of fortified products to potentially increase fortified food consumption.

The Impact of Micronutrient Fortified Foods on Cognitive Functioning Among Low-Income Children: A Pilot Study (P18-096-19)

ObjectivesTo examine the association between micronutrient fortified food consumption compared with standard foods and cognitive functioning among low-income children. MethodsLow-income children (ages 8–12 years) participating in an afterschool program were recruited for this randomized-controlled trial. At baseline, trained research assistants measured IQ (Shipley-2 Composite Standard Scores) and cognitive functioning (Stroop Color Word Test [Golden Version], Trail Making Test, and Conners Continuous Performance Test [CPT-3]) to evaluate executive functioning, selective attention, and processing speed. Children were then randomly assigned to receive either micronutrient fortified foods (n = 19) or to continue receiving standard foods (n = 16) daily at the afterschool program for approximately three months. The intervention foods contained 75% Daily Value for all essential vitamins and minerals, omega-3 and omega-6 fatty acids, protein, one cup of milk, and one serving of fruits. The standard foods consisted of juice and primarily processed meats with refined grains. The cognitive tests were re-administered post-implementation. Differences in cognitive scores between the intervention and control groups were assessed using repeated measures ANOVAs and ANCOVAs, adjusting for age ResultsA total of n = 35 children were eligible to participate and had regular attendance at the afterschool program during the study period. When examining differences between the control and intervention groups over time, the results were suggestive of a trend towards the control group performing worse over time CPT Omissions T-scores (P = 0.10), CPT Hit Reaction Time (HRT) T-scores (P = 0.06), and CPT HRT Block Change T-Score (P = 0.09) compared with the intervention group. However, there was a trend towards worse performance in the intervention group on CPT Perseverations T-Scores (P = 0.07) compared with the control group. There were no significant differences between-groups over time on the Trail Making test or Stroop test ConclusionsOverall, there was some evidence of improved cognitive scores over time among low-income children provided with micronutrient fortified foods relative to the control group. It is possible that these nutrient-dense, fortified foods may be cognitively protective in this population and future larger studies should examine these associations Funding SourcesThis study was funded by an unrestricted gift from the 43ForKids Foundation.

Different Socio-Demographic and Lifestyle Factors Can Determine the Dietary Supplement Use in Children and Adolescents in Central-Eastern Poland.

Vitamin/mineral supplement (VMS) use has become increasingly popular in children and adolescents; however, different predictors may be associated with their usage. Therefore, the aim of this study was to compare determinants of VMS use in 1578 children and adolescents. Data was collected among parents of children (≤12 years old) and among adolescents (>12 years old) who attended public schools by a self-administered questionnaire. Multivariate-adjusted logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for determining the predictors of VMS use. In children, the following determinants of VMS use were indicated: socioeconomic status (average vs. very good/good; OR: 1.69, 95% CI: 1.16–2.48), physical activity (1–5 vs. <1 h/week; OR: 1.44, 95% CI: 1.02–2.04), BMI (≥25 vs. 18.5–24.9 kg/m2; OR: 0.67, 95% CI: 0.46–0.98), and presence of chronic diseases (yes vs. no; OR: 2.32, 95% CI: 1.46–3.69). In adolescents, gender (male vs. female; OR: 0.56, 95% CI: 0.37–0.87), residential area (rural vs. urban; OR: 0.63, 95% CI: 0.40–0.99), BMI (<18.5 vs. 18.5–24.9 kg/m2; OR: 0.35, 95% CI: 0.17–0.73), and health status (average/poor vs. at least good; OR: 1.96, 95% CI: 1.13–3.39) were factors of VMS use. In both groups, the mother’s higher educational level, fortified food consumption and diet modification towards better food choices were predictors of VMS use. In conclusion, most of the predictors of VMS use were different in children and adolescents.

Complementary feeding practices and nutritional status of children 6-23 months old: formative study in Aceh, Indonesia.

BACKGROUND/OBJECTIVESThe 6–23 months for infants is the longest period in the “first 1,000 days” of life. This period is very important for child development, so complementary feeding (CF) practices should be optimized to maximize children's potential for growth and development. The aim of this study was to analyze the CF practices and nutritional status of children aged 6–23 months.SUBJECTS/METHODSFor this cross-sectional study, 392 children aged 6–23 months were selected using stratified random sampling. Socio-demographic data were collected through interviews. CF practices, collected by interviews and repeated 24-hour food recall method, were the timely introduction of CF, minimum meal frequency, dietary diversity and minimum acceptable diet, consumption food rich in proteins and vitamin A. Nutritional status was assessed using the indicators of underweight, wasting and stunting. To analyze the association between socio-demographic indicators and CF with nutritional status, the chi-square test with a confidence interval of 95% was used.RESULTSResults showed that 39% were exclusively breastfed, only 61% received prolonged breastfeeding and 50% received timely introduction of CF. Minimum meal frequency was met by 74% of subjects, but dietary diversity and minimum acceptable diet were only realized in 50% and 40% of the children, respectively. The prevalence of underweight, wasting, and stunting were 26%, 23%, and 28%, respectively. Age of the child, birth order, birth weight, parents' education level, family size and incidence of fever and diarrhea during the previous two weeks were associated with underweight, while child's birth order, fathers' education level, mother's age, family size, completion of the age-appropriate vaccination and fish consumption frequency were associated with wasting. Age of the child, incidence of fever and acute respiratory infection, and fortified food consumption were associated with stunting.CONCLUSIONSSuboptimal CF practices and high prevalence of underweight, wasting and stunting were found among children aged 6–23 months old in Aceh. These results highlight the need to improve CF and nutritional status.

Consumption of fortified infant foods reduces dietary diversity but has a positive effect on subsequent growth in infants from Sumedang district, Indonesia.

Stunting and underweight among under-five children in Indonesia are common, raising public health concerns. Whether inappropriate complementary feeding (CF) practices compromise optimal growth during late infancy in Indonesia is uncertain. Therefore we characterized and evaluated CF practices in Indonesian infants and investigated their relationship with subsequent growth. We enrolled breastfed infants at 6 months of age (n = 230); and followed them at 9 (n = 202) and 12 months of age (n = 190). We collected socio-demographic and anthropometric data and two-day in-home weighed food records. Relations between WHO CF indicators, sentinel foods, and energy and micronutrient intakes at 9 months and growth at 12 months were explored using multiple linear regression. Stunting and underweight increased from 15.8% and 4.4% at 6 months to 22.6% and 10.5% at 12 months, respectively. Median intakes of calcium, iron, zinc, and riboflavin were below WHO recommendations. Infants consuming fortified infant foods (FIFs) at 9 months had diets with a lower dietary diversity (DD) score (2.3 vs.3.0), energy density, median energy (250 vs. 310 kcal/d) and protein (6.5 vs. 9.1 g/d) intake than non-consumers (p<0.01), despite higher intakes of calcium, iron, and vitamins A and C (p<0.001). Positive relations existed for 9-month consumption of iron-rich/iron fortified infant foods with length-for-age Z-score (LAZ) at 12 months (β = 0.22; 95% CI: 0.01, 0.44; P = 0.04), and for fortified infant foods alone with both LAZ (β = 0.29; 95% CI: 0.09, 0.48; P = 0.04) and weight-for-age Z-score (β = 0.14; 95% CI: 0.02, 0.26; P = 0.02) at 12 months. The positive association of FIFs with subsequent growth may be attributed to their content of both powdered cow’s milk and multi-micronutrient fortificants. Nonetheless, mothers should not be encouraged to over-rely on FIFs as they reduce DD.

Small Increments in Vitamin D Intake by Irish Adults over a Decade Show That Strategic Initiatives to Fortify the Food Supply Are Needed1–4

Food fortification could be an effective method of increasing vitamin D intakes and preventing deficiency with minimal risk of excessive dosing. Secular trends in vitamin D intakes were examined over a 10-y period. We compared vitamin D intakes among 18- to 64-y-old adults from the base diet, fortified foods, and supplements in 2 nationally representative dietary surveys in 1999 and 2009 implemented using the same methodology. There was a slight increase in the median (IQR) intake of vitamin D from 2.9 (3.2) to 3.5 (3.7) μg/d (mean ± SD, 4.3 ± 4.0 to 5.0 ± 6.4 μg). The median (IQR) intake from the base diet was 2.3 (1.6) μg/d in 1999 and 2.1 (1.8) μg/d in 2009. In vitamin D supplement users, median (IQR) intakes were 7.6 (6.7) and 8.7 (7.2) μg/d and the prevalence of inadequacy decreased from 67% to 57% in 2009. Although the consumption of vitamin D-containing supplements was similar in the 2 surveys (17% and 16%), the use of calcium-vitamin D supplements increased from 3% to 10% among women aged 50-64 y. The prevalence of fortified food consumption was also similar at 60%, and median (IQR) vitamin D intakes in consumers were 2.9 (2.2) and 3.7 (2.9) μg/d in 1999 and 2009, respectively. Mathematical modeling of food fortification using modified vitamin D composition data showed that there is potential to increase vitamin D intakes at the lower end of the distribution, without increasing the risk of exceeding the Tolerable Upper Intake Level. We report small increases in vitamin D intakes among Irish adults over a decade of focus on vitamin D and in the context of a voluntary fortification policy. Strategic management of vitamin D in the food supply is required to yield measurable benefits.

A review of the cut-off points for the diagnosis of vitamin B12 deficiency in the general population.

Vitamin B12 deficit is one of the most common vitamin deficiencies. However, there is no consensus on the cut-off points for vitamin B12 and its co-markers, such as folate, holotranscobalamin, methylmalonic acid and homocysteine. In order to establish the state of the art about cut-off points used to determine vitamin B12 deficiency in the last decades, the database MEDLINE was used for searching studies published in adults between December 1992 and May 2014 (69 articles), using search terms like 'vitamin B12', 'cobalamin', 'cut-off', 'deficiency' alone or in combinations. Broad ranges of cut-off points for vitamin B12 and its biomarkers were identified: vitamin B12 ranged between 100 pmol/L and 350 pmol/L, holotranscobalamin 20-50 pmol/L, methylmalonic acid 0.210-0.470 μmol/L, homocysteine 10-21.6 μmol/L, serum folate 3.7-15.9 nmol/L and red blood cell 124-397 nmol/L. For the majority of studies, the potential influence of age, analytical methods, gender and fortified food consumption was not taken in account when choosing cut-off values. This could explain the discrepancies between studies on vitamin B12 and folate deficiency prevalences. We conclude that there is inconsistency in the literature regarding vitamin B12 cut-offs. It would be necessary to establish different reference cut-offs according to age, considering the analytical methods used.

Distribution of Vitamin E Intake among Japanese Dietary Supplement and Fortified Food Users: A Secondary Analysis from the National Health and Nutrition Survey, 2003-2009

This study was performed to: (1) assess the prevalence of dietary supplement and fortified food use, (2) examine the differences in vitamin E intake with and without dietary supplementation and/or fortified food use, and (3) determine whether some individuals consume vitamin E above the tolerable upper intake level (UL). Data were obtained from 64,624 individuals (age, ≥1 y; 47.4% males) who completed a 1-d household dietary assessment that was part of the National Health and Nutrition Survey conducted in Japan, 2003-2009. The survey also obtained information on the brand or generic name of each dietary supplement or fortified food reported, including their ingredients, through dietary assessment. The prevalence of a potential risk of excess was estimated by the proportion of persons above the age-/sex-specific ULs provided by the Dietary Reference Intakes for Japanese 2010. Supplement use was reported by 5.8% of men and 7.7% of women, whereas fortified food consumption was reported by only 2.9% of men and 3.6% of women. Use of dietary supplements was most common among older women, whereas use of fortified foods was most common among younger women. Both dietary supplement and fortified food use accounted for maximum vitamin E intake; however, the use of dietary supplements and fortified foods had little effect on the median and 95th percentile intake values. None of the subjects consumed nutrients above the UL. The collected data confirm that the use of both dietary supplements and fortified foods contributes a small amount to nutrient intake in Japanese subjects.

Fortified food consumption: impact on micronutrient adequacy and compliance with dietary recommendations in Irish children 1–4 years

Fortified food consumption: impact on micronutrient adequacy and compliance with dietary recommendations in Irish children 1–4 years

Limitations of Food Composition Databases and Nutrition Surveys for Evaluating Food Fortification in the United States and Canada

BackgroundAs the availability of fortified foods expands, it is increasingly important to monitor risk of excessive nutrient intake. However, neither Canadian nor US nutrient composition databases systematically differentiate between naturally occurring nutrients and those added to foods at manufacturers’ discretion, and the consumption of fortified foods is not comprehensively assessed during dietary data collection. ObjectiveTo describe limitations in the estimation of nutrient intakes from voluntarily fortified foods from the Canadian Community Health Survey (CCHS 2004) and National Health and Nutrition Examination Survey (NHANES 2007-08) for the purposes of evaluating fortification policies and practices. DescriptionWorking with the US Food and Nutrient Database for Dietary Studies, we identified voluntarily fortified foods by food code descriptions containing certain key words and the presence of nutrients for which additions were tracked in the database. This strategy is likely to have resulted in an underestimation of voluntarily fortified food consumption and thus an underestimation of the probability of excessive intakes in the US population. Our efforts to model proposed policy changes to food fortification in Canada were similarly limited by our inability to differentiate added sources of niacin and retinol in the CCHS. This thwarted assessment of risks associated with fortification because the Tolerable Upper Intake Levels only apply to retinol and added niacin. ConclusionIt is important that food composition databases and 24hr dietary recall collection methods evolve to facilitate monitoring and evaluating health benefits and risks associated with growing voluntary food fortification practices.