Inappropriate Intake Research Articles

Assessment of nutrient adequacy in undergraduate students during the undertaking shipboard internship: using 12-day dietary recall through smartphone photography

BackgroundThis study aimed to investigated nutritional status and estimated the adequacy of dietary intake of university students during shipboard internships.MethodsIn this cross- sectional study, data were collected from 25 students out of 42 participants who attended in the research information session in the department of maritime at a university located in Jeonbook, South Korea. The dietary intake data was obtained using the 12-day dietary recall through smartphone photography during the shipboard internships. The data on dietary intake were used to calculate acceptable macronutrient distribution ranges (AMDRs), frequency of inappropriate intake of the 2020 Dietary Reference Intakes for Koreans (KDRIs) as a reference, intake ratio to the nutrient adequacy ratio (NAR), mean adequacy ratio (MAR), and index of nutritional quality (INQ).ResultsThe average age of subjects was 21.68 years and average BMIs in men and women were 25.67 kg/m2 and 23.44kg/m2, respectively. The average energy of men and women was 2018.66 kcal and 1727.87 kcal, respectively. More than half of the subjects did not meet the inappropriate range of the AMDRs for carbohydrates and fat. The NAR of vitamin A, vitamin C, and calcium among all 10 nutrients tended to be lower in both men and women. The MAR were 0.71 and 0.769. On the other hand, in both men and women, vitamin C had the lowest INQ (0.5 and 0.39). For men, grains and potatoes were the major contributors to energy and carbohydrates, and calcium contributed in the order of meat, fish and eggs and vegetables and fruits. Although the highest contributors to energy and carbohydrates for women were grains and potatoes, the contributions from meat, fish, and eggs were similar, and the major contributors to calcium were vegetables and fruits.ConclusionsTo improve the inadequate nutritional status of university students engaged in shipboard internships with the aim of pursuing careers as seafarers, there is a need to provide additional nutritional education tailored to their specific circumstances. Additionally, professional health guidance should be provided to maintain optimal nutritional status.

Dietary Antioxidants, Quality of Nutrition and Cardiovascular Characteristics among Omnivores, Flexitarians and Vegetarians in Poland-The Results of Multicenter National Representative Survey WOBASZ.

Several reports have shown that more plant-based dietary patterns provide a higher intake of antioxidants compared to diets rich in meat and animal products. Data on the intake of key nutrients in cardiovascular disease (CVD) prevention in relation to particular diets in countries of Central and Eastern Europe are scarce. The aim of this study was to assess quality of nutrition and CVD characteristics in a representative sample of Polish adults following different dietary patterns. Special regard was paid to the intake of natural antioxidants. The study comprised 13,318 (7159 females) randomly selected adults aged ≥ 20 years participating in the National Multicentre Health Surveys WOBASZ and WOBASZ II. The subjects were categorized into groups of omnivores (92.4%), flexitarians (7.4%) and vegetarians (0.16%) according to type of diet using the Food Frequency Questionnaire and 24 h dietary recall. The obtained results showed that neither flexitarians nor vegetarians represented better dietary habits or lifestyle behaviors compared to omnivores. Flexitarians had significantly lower daily energy intake than omnivores, but their diet was rich in total fat (above 30% of daily energy consumption) and low in fiber. Omnivores declared a higher consumption of fresh vegetables (p < 0.001), fresh fruit (p < 0.01), coffee (p < 0.01) and tea (p < 0.05, in women only) than flexitarians. Omnivores had significantly higher intake of natural antioxidants (vitamin C, E, zinc in both genders and vitamin A in men) as compared with flexitarians. Among women, the highest adherence to the intake of recommended amounts of antioxidant nutrients was noted among omnivores. Among men, vegetarians had the highest proportion of meeting the guidelines for vitamin A (77.8%), E (66.7%) and C (66.7%), while the lowest proportions were found in flexitarians (69.9%, 39.5% and 32.4%, respectively). The groups did not differ in terms of smoking and physical activity level. There were no significant differences in the analyzed CVD characteristics between omnivores and flexitarians. In women, vegetarians had substantially lower BMI than omnivores (p < 0.05) and flexitarians (p < 0.05) and a lower mean serum glucose compared with omnivores (p < 0.01) and flexitarians (p < 0.05). Vegetarians had lower prevalence of hypertension and obesity than meat eaters. In conclusion, the results of the current research showed an inappropriate intake of several nutrients, including highly potent antioxidants, irrespective of the dietary regimen. Flexitarians did not have a more favorable CVD profile than omnivores. Taking into account the growing popularity of diets with reduced animal products, there is a need to elaborate strategies providing Polish adults with guidance regarding properly balanced nutrition.

Food safety – From pioneering steps to the modern scientific discipline

Food safety is a story that unites all civilizations, cultures, and nations, and it is interlaced with various methods for making food safer. Concern for nutritious and safe food is as ancient as humankind itself, and many of the food safety issues that persist today are not new. Diverse records from the ancient world, as well as the religious writings of the three monotheist religions, actually refer to food, its intake, and prohibitions, as well as pathological diseases that may follow from inappropriate intake. Over time, food safety has evolved into a scientific discipline concerned with the handling, preparation, transport, and distribution of food to avoid the transmission of illnesses. The current state of food safety knowledge is the result of past discoveries, innovations, and laws. In modern times, the right to consume safe food is a fundamental human right. It contributes to and promotes sustainable development while supporting the economy, trade, and tourism. Nevertheless, despite significant improvements, we still know relatively little about food-borne illnesses and how infections affect humans.

Penicillin V prophylaxis uptake among children living with sickle cell disease in a specialist sickle cell clinic in Ghana: A cross-sectional study.

Penicillin V prophylaxis protects children living with sickle cell disease (SCD) from bacteria infections especially Streptococcus pneumonia. However, the uptake of penicillin V prophylaxis is difficult to assess and often poor among SCD patients. Therefore, this study sought to investigate oral penicillin V prophylaxis adherence among SCD children using urine assay and self-reported methods and the associated factors. The study employed an analytical cross-sectional design in the assessment of penicillin V prophylaxis adherence using both urine assay and self-reported methods. Multiple logistic regression analysis was used to determine the factors associated with penicillin V prophylaxis adherence. A pvalue < 0.05 was considered statistically significant. Among the 421 SCD patients recruited, penicillin V prophylaxis adherence was observed to be 30.0% and 68.0% for the objective and subjective methods of assessment, respectively. For the objective method of assessment, being cared for by grandparents increased the odds of penicillin V adherence (adjusted odds ratio[aOR] = 3.68, confidence interval[CI] = 1.03-13.15). However, SCD patients within the ages of 10-14 years (aOR = 0.36, CI = 0.17-0.80), >14 years (aOR = 0.17, CI = 0.05-0.61), SCD patient cared for by married caregivers/parents (aOR = 0.32, CI = 0.14-0.72), SCD patient cared for by divorced caregivers/parents (aOR = 0.23, CI = 0.07-0.75), SCD patients taking homemade (herbal) preparations for the treatment of SCD (aOR = 0.42, CI = 0.21-0.83), and inappropriate intake of penicillin V prophylaxis (aOR = 0.27, CI = 0.11-0.67) reduced the odds of penicillin V adherence. For the subjective method of assessment, taking homemade preparation (herbal) for the treatment of SCD (aOR = 0.52, CI = 0.30-0.89) and inappropriate intake of penicillin V (aOR = 0.32, CI = 0.17-0.60) reduced the odds of penicillin V adherence. This study reports a relatively low adherence rate of penicillin V prophylaxis among children living with SCD. Educating and counseling both SCD patients and/or caregivers on the need to be adherent to penicillin V prophylaxis could prevent complications that may arise from nonadherence.

Omeprazole treatment manifests anxiolytic effects in a cysteamine hydrochloride induced mouse model of gastrointestinal disorder

Omeprazole, a proton pump inhibitor (PPI), has widely been used to treat various gastrointestinal (GI) disorders. Notably, many clinical symptoms of GI disorders have been known to be associated with anxiety. In recent years, an exponentially increased number of subjects with abnormal ageing, neurological deficits, and psychiatric problems simultaneously exhibit GI dysfunctions as well as anxiety. Considering the fact, drugs that are used to treat GI disorders can be speculated to mitigate anxiety-related symptoms, and vice versa. Although, omeprazole treatment has been reported to result in development of anxiety and neurocognitive decline, ample reports suggest that omeprazole treatment is beneficial for the positive regulation of neuroplasticity. While underlying mechanisms of omeprazole-mediated neurological alterations remain obscure, the available scientific data on the omeprazole induced adverse effects in the brain appear to be inadequate, uncertain, and controversial. Hence, this study revisited the effect of omeprazole treatment on the degree of anxiety-like behaviours in a cysteamine hydrochloride (HCl) induced mouse model of GI disorder using open field test (OFT), light-dark box (LDB) test and elevated plus maze (EPM). Results revealed that omeprazole treatment mitigates anxiety-related behaviours in the cysteamine HCl induced animal model of GI disorder. Thus, this study assuredly supports and validates the anxiolytic properties of omeprazole. However, the adverse effects associated with inappropriate intake of omeprazole may not completely be excluded. Therefore, this study advocates the future direction in determining the long-term effects of omeprazole on the brain functions.

Types of screening tools used to identify potential inappropriate medication in the geriatric

Inappropriate intake of medications can increase the risk of many morbidities and mortality among the geriatric population. Therefore, assessment of drug underuse, overuse, and inappropriate use has been an area of interest across the different investigations, and according to which, different screening tools were developed to identify these problems and enhance the quality of care to these patients. In the present study, we aim comprehensively discuss the different types of currently reported screening tools that can identify potentially inappropriate medication in the geriatric population. Studies show that assess, review, minimize, optimize, reassess (ARMOR), and medication appropriateness index (MAI) tools are the most commonly reported for this purpose to appropriately evaluate drug administration practices. However, they are time-consuming and need adequately trained personnel, which might not be available within the different settings. Accordingly, we suggest that more than one tool should be used, as we have reviewed all the advantages and disadvantages of the modality within the current study, to adequately facilitate and make the process of evaluation easy and enhance the quality of care for the geriatric population.

A lower maximum bite force is a risk factor for developing cardiovascular disease: the Suita study

Decreases in masticatory function are believed to be related to the development of cardiovascular disease (CVD) through inappropriate nutritional intake. This study focused on maximum bite force (MBF), which is an objective, quantitative index of masticatory function, and its association with the development of CVD (stroke and coronary heart disease) was investigated. The subjects were 1547 participants of the Suita study with no history of CVD who underwent medical and dental health examinations between June 2008 and June 2013. In addition to undergoing a basic physical examination at baseline, their MBF was measured. They subsequently underwent follow-up surveys for the development of CVD (mean follow-up, 3.5 years). The association between baseline MBF and the development of CVD was investigated by multivariate adjustment using a Cox proportional hazards model. CVD developed in 32 subjects during follow-up. The trend test showed a significant association between baseline MBF and CVD in a model that combined men and women. When analysed by sex, the trend test found a significant association between baseline MBF and CVD in women. Low MBF, which is an objective and quantitative index of masticatory function, may be a risk factor for the development of CVD.

Nutrition and the Covid-19 pandemic: Three factors with high impact on community health

AimsIn the course of the COVID-19 pandemic, multiple suggestions have been delivered through websites and social media referring to natural substances and various kinds of supplements with thaumaturgical properties in preventing and/or fighting the coronavirus infection. Indeed, there is no clinical trial evidence that a dietary or pharmacological supplementation of any particular substance will increase the effectiveness of the immune defences. There are however three nutritional issues that deserve special attention under the present circumstances, namely vitamin D deficiency, excess salt intake and inappropriate alcohol consumption. Here is a short review of the current knowledge about the possible role of these factors in the immunity defence system and their potential impact on the modulation of the immune response to SARS-COV2 infection. Data synthesisFor all of these factors there is convincing evidence of an impact on the immune defence structure and function. In the absence of RCT demonstration that increased ingestion of any given substance may confer protection against the new enemy, special attention to correction of these three nutritional criticisms is certainly warranted at the time of COVID pandemic. ConclusionsWe propose that the inappropriate intake of salt and alcohol and the risk of inadequate vitamin D status should be object of screening, in particular in subjects at high mortality risk from SARS-COV 2 infection, such as institutionalised elderly subjects and all those affected by predisposing conditions.

Historical Relationship of Feeding with Stunting Events of Children Under Two Years of Age 6-23 Months in District Malili, Luwu Timur Regency

Stunting reflects chronic malnutrition during the most critical period of growth and development in early life, namely ages 0-24 months. Giving inappropriate intake in this early period will have an impact on conditions in the form of stunting nutritional status in children. The purpose of this study was to analyze the relationship between feeding history and the incidence of baduta (children under two years of age) stunting (6-23 months) in Malili District, East Luwu Regency. This type of research is a quantitative study with cross-sectional study design. The population of the study was all 738 baduta in the Malili district. The research sample was 260 baduta and mother baduta as respondents who were taken by simple random sampling. Data were analyzed using chi-square and logistic regression. The results showed that 31.9% of baduta (children under two years of age) were stunted. The results of the Chi-square test showed that colostrum (p = 0.000), prelactal (p = <0.000), and exclusive breastfeeding (p = <0.000) were associated with the incidence of stunting. The results of the logistic regression test showed that there was a significant effect of giving colostrum (p = 0.035) and exclusive breastfeeding (p = 0.008) on the incidence of stunting. The variable with the greatest influence on the incidence of stunting was exclusive breastfeeding with an OR = 2.533. It is suggested to increase counseling about breastfeeding in the early stages from pre-marriage to pregnancy.

Effects of Probiotics and Prebiotics on Frailty and Ageing: A Narrative Review.

Globally, the population over the age of 60 is growing fast, but people age in different ways. Frailty, shown by the accumulation of age-related deficits, is a state of increased vulnerability to adverse outcomes among people of the same chronological age. Ageing results in a decline in diversity and homeostasis of microbiomes, and gut flora changes are related to health deficit accumulation and adverse health outcomes. In older people, health deficits including inappropriate intake, sarcopenia, physical inactivity, polypharmacy, and social vulnerability are factors associated with gut dysbiosis. The use of probiotics and prebiotics is a cost-effective and widely available intervention. Intake of probiotics and prebiotics may improve the homeostasis of gut microflora and prevent frailty and unhealthy aging. However, health effects vary among probiotics and prebiotics and among individual populations. This narrative review summarizes recent evidence about the relationship between prebiotic and probiotic consumption with health outcomes in older people.

Maternal selenium deficiency during pregnancy in mice increases thyroid hormone concentrations, alters placental function and reduces fetal growth.

Inappropriate intake of key micronutrients in pregnancy is known to alter maternal endocrine status, impair placental development and induce fetal growth restriction. Selenium is an essential micronutrient required for the function of approximately 25 important proteins. However, the specific effects of selenium deficiency during pregnancy on maternal, placental and fetal outcomes are poorly understood. The present study demonstrates that maternal selenium deficiency increases maternal triiodothyronine and tetraiodothyronine concentrations, reduces fetal blood glucose concentrations, and induces fetal growth restriction. Placental expression of key selenium-dependent thyroid hormone converting enzymes were reduced, whereas the expression of key placental nutrient transporters was dysregulated. Selenium deficiency had minimal impact on selenium-dependent anti-oxidants but increased placental copper concentrations and expression of superoxide dismutase 1. These results highlight the idea that selenium deficiency during pregnancy may contribute to thyroid dysfunction, causing reduced fetal growth, that may precede programmed disease outcomes in offspring. Selenium is a trace element fundamental to diverse homeostatic processes, including anti-oxidant regulation and thyroid hormone metabolism. Selenium deficiency in pregnancy is common and increases the risk of pregnancy complications including fetal growth restriction. Although altered placental formation may contribute to these poor outcomes, the mechanism by which selenium deficiency contributes to complications in pregnancy is poorly understood. Female C57BL/6mice were randomly allocated to control (>190µgkg-1 , n=8) or low selenium (<50µgkg-1 , n=8) diets 4weeks prior to mating and throughout gestation. Pregnant mice were killed at embryonic day 18.5 followed by collection of maternal and fetal tissue. Maternal and fetal plasma thyroid hormone concentrations were analysed, as was placental expression of key selenoproteins involved in thyroid metabolism and anti-oxidant defences. Selenium deficiency increased plasma tetraiodothyronine and triiodothyronine concentrations. This was associated with a reduction in placental expression of key selenodependent deiodinases, DIO2 and DIO3. Placental expression of selenium-dependent anti-oxidants was unaffected by selenium deficiency. Selenium deficiency reduced fetal glucose concentrations, leading to reduced fetal weight. Placental glycogen content was increased within the placenta, as was Slc2a3mRNA expression. This is the first study to demonstrate that selenium deficiency may reduce fetal weight through increased maternal thyroid hormone concentrations, impaired placental thyroid hormone metabolism and dysregulated placental nutrient transporter expression. The study suggests that the magnitude of selenium deficiency commonly reported in pregnant women may be sufficient to impair thyroid metabolism but not placental anti-oxidant concentrations.

Estimation of exposures to non-nutritive sweeteners from consumption of tabletop sweetener products: a review

ABSTRACTReliable estimation of intake of non-nutritive sweeteners (NNS) from tabletop sweetener products (TTS) is complex. Some TTS contain more than one type of NNS and more importantly, there can be considerable formula variation between different types of TTS products; that is liquid, powder and tablet products. A survey of use levels (mg NNS/kg TTS retail product) confirmed wide variations and reflected major differences in the portion size, or mass, typically used to deliver a sweetness equivalent to around one teaspoon (tsp) of sugar. This paper reviews current intake estimation models and reveals that these models may result in inappropriate intake estimations, probably because some surveys did not discriminate between powder, tablet and liquid forms. The data suggest that using upper percentile consumption figures for powdered forms is a critical factor in intake estimations and may be a more realistic method by which overall exposure estimates could be obtained.

English

The provision of cheap, balanced and adequate nutritional composition for growing infants is a major challenge in Africa. Most weaning foods are usually cereal-based gruels fermented by lactic acid bacteria (LAB). The major nutrient they supply being carbohydrate, uncontrolled or inappropriate intake might cause growth retardation and malnutrition in growing children. The nutritional requirement of weaning infants could be supplied by supplementation with protein rich diets. Soybean is a cheap and available source of protein in Nigeria; but it also contain some complex sugars (raffinose) which is associated with abdominal discomfort in children of weaning age. This study is designed to use the probiotics LAB to improve the nutritional composition of weaning food blends. Lactic acid bacteria were isolated from Ogi (a fermented cereal gruel) using standard morphological and biochemical tests; their identities were confirmed with molecular methods. Nutritional and organoleptic attributes of the food blend were determined following Association of Official Analytical Chemist procedures. The data were subjected to statistical analysis at 5% level of significance. Fortification of the gruel with pre-treated soybeans improved the nutritional quality (Protein: 8.4 to 17.8 %; Fat: 3.6 to 12.9 %; Ash: 2.0 to 3.8%; Fe: 6.4 to 10.7mg/100g and Ca: 156.7 to 211.0mg/100g) during fermentation. Utilization of raffinose by probiotic Lactobacillus plantarum from local food sources reduced the complex sugars in soybeans. Nutritional qualities and organoleptic attributes of cereal gruels were improved by fortification with soybeans and fermentation. Key words: Probiotics, complex sugars, Lactobacillus plantarum, fermentation, nutritional improvement, soybeans.

Inappropriate nutrients intake is associated with lower functional status and inferior quality of life in older adults with depression.

ObjectivesThe study is a case-control analysis of whether depression impairs physical and cognitive functioning and quality of life, and whether there is a relationship between nutrient deficiencies and these adverse changes.Patients and methodsA total of 130 older subjects participated in the study: 65 with diagnosed depression (16 men and 49 women) and 65 age- and sex-matched controls without depression. All patients underwent comprehensive geriatric assessment. Nutritional state was assessed with the Mini Nutritional Assessment, cognitive performance was evaluated by the Mini-Mental State Examination and physical functioning by the Timed “Up & Go” test and handgrip strength. The pattern of consumption of various nutrients was analyzed in detail.ResultsThe differences in cognitive functioning observed between the groups were related to specific nutrient intake, as was handgrip strength to some extent. The differences in nutritional status, several functional tests and muscle strength were related to both the presence of depression and inappropriate consumption of certain nutrients.ConclusionThe incidence of falls and poor quality of life may be partially associated with the presence of depression. The inappropriate intake of selected nutrients may impair the functioning and quality of life of older adults with depression, such as the excess consumption of sucrose and insufficient consumption of protein, fiber, eicosapentaenoic acid, niacin and vitamin B6. Particular nutrients should be translated into dietary patterns which allow the individual patient to address these nutrient deficiencies.

Socio-economics, food habits and the prevalence of childhood obesity in Spain.

In 2012, the prevalence of obesity and overweight statuses among children in Spain was 9% and 26%, respectively. Concerns about childhood obesity have increased over the past few years, as obesity developed during childhood can persist throughout an individual's lifetime (cohort effect). This study aims to develop a better understanding of the factors influencing the prevalence of obesity in Spain. Microdata from the 2012 National Health Survey are used, and the methodological framework is based on the estimation of a sample selection model. Results suggest that the prevalence of obesity increases among children who live in households of a lower socio-economic status and households in which parents are obese. Lower levels of childhood physical activity are positively related to the probability of being obese. Finally, there exists a positive relationship between children's body mass index and an inappropriate intake of fresh fruits, fish, pasta and rice, legumes, sweets and soft drinks. The methodological framework used in this study is flexible enough to be used in traditional longitudinal studies. Children's and households' lifestyles play a pivotal role in the prevalence of obesity. Policies should be oriented toward changing lifestyles, which would require more multidisciplinary research in the future to reduce childhood obesity.

Feeding of children exposed to the human immunodeficiency virus at birth

The aim was to characterize feeding aspects of children born exposed to the Human Immunodeficiency Virus. Cross-sectional study was developed at a referral hospital for infectious diseases in Fortaleza-Ceará, Brazil, between January and June 2010. The sample consisted of 62 mothers who provided information on 64 children born exposed to the virus. In the nursing consultation, the Assessment Scale of Care Skills for Children Exposed to Human Immunodeficiency Virus at Birth and forms for sociodemographic and dietary characterization were used. It was found that 57.8% of children had inappropriate intake of milk, 55.0% had inappropriate complementary feeding, 87.0% of mothers had a high capacity to offer milk powder and, in relation to complementary feeding, the ability ranged from moderate (45.7%) to high (48.5%). Thirteen nursing diagnoses showing feeding problems and deficits in care that require nursing interventions appropriate to the social context of each patient were identified.

Inadequate food intake among adults living with HIV

CONTEXT AND OBJECTIVE The number of people living with HIV (PLHIV) in Brazil is between 600,000 and 890,000. Assessing the diet is important in planning healthcare actions and improving PLHIV's quality of life. This study aimed to estimate the prevalence of inappropriate protein, total fat, saturated fat, carbohydrate, fiber, sodium, calcium and cholesterol intake among PVHIV on highly-active antiretroviral therapy (HAART). DESIGN AND SETTING Cross-sectional study in nine Specialized STD/AIDS Healthcare Centers in São Paulo. METHODS Men and women aged 20 to 59 years, on HAART for at least three months, were included. Nutrient intake was assessed using 24-hour food recall applied in person and repeated among 30% of the population by telephone. The between and within-person variances were corrected. RESULTS 507 individuals were evaluated: 58% male, mean age 41.7 years (standard deviation, SD = 7.8). The mean time since HIV diagnosis was 6.6 years (SD = 4.1), and since HAART onset, 5.1 years (SD = 3.3). More than 20% of the population presented intake above the recommendations for saturated fat, cholesterol and/or sodium, and below the recommendations for fiber. The recommended maximum tolerable sodium level was exceeded by 99% of the sample, and 86% of men and 94% of women did not reach the daily recommendations for calcium. Protein, carbohydrate and total fat intakes were adequate for the majority of the population. CONCLUSIONS A significant portion of the population presented inappropriate intake of saturated fat, sodium, fiber and calcium. Interventions aimed at improving PLHIV's dietary quality are needed.

Testing the performance of microbiological safety cabinets used in microbiology laboratories in South Korea

To test a performance of the microbiological safety cabinets (MSCs) according to the type of MSCs in microbial laboratories. Tests were carried out to assess the performance of 31 MSCs in 14 different facilities, including six different biological test laboratories in six hospitals and eight different laboratories in three universities. The following tests were performed on the MSCs: the downflow test, intake velocity test, high-efficiency particulate air filter leak test and the airflow smoke pattern test. These performance tests were carried out in accordance with the standard procedures. Only 23% of Class II A1 (8), A2 (19) and unknown MSCs (4) passed these performance tests. The main reasons for the failure of MSCs were inappropriate intake velocity (65%), leakage in the HEPA filter sealing (50%), unbalanced airflow smoke pattern in the cabinets (39%) and inappropriate downflow (27%). This study showed that routine checks of MSCs are important to detect and strengthen the weak spots that frequently develop, as observed during the evaluation of the MSCs of various institutions. Routine evaluation and maintenance of MSCs are critical for optimizing performance.

Encouraging healthy beverage intake in child care and school settings

Inappropriate intake of sugar-sweetened beverages, fruit juice, and whole milk is associated with obesity and obesity-related comorbidities. As numerous children spend many hours in schools and child care, these settings provide a potential means for general pediatricians to reach children and their parents with interventions to encourage intake of guideline-recommended beverages. This review describes the beverages currently offered within child care facilities and schools and summarizes school and child care-based interventions and policies to encourage healthy beverage intake. The major sources of beverages available in schools and child care include beverages provided through federal programs, competitive beverages (e.g., beverages for purchase through vending machines), water from drinking fountains, and beverages brought into facilities. Policies governing the types of beverages available in schools and child care settings have increased, but still vary in scope and jurisdiction. Although there are no child care-based interventions that exclusively target beverage intake, there are examples of school-based interventions to encourage healthy beverage consumption. Although interventions and policies to encourage healthy beverage intake in schools and child care are increasing, there is a need for additional research, programs, and policies to guide beverage availability and intake in these settings.

Rheuma und Entzündungskontrolle durch Ernährung

Research work of the last decade has revealed dietary options to attenuate inflammation in rheumatic diseases via the eicosanoid system. Dietary means are reduction of arachidonic acid intake with a modified lactovegetarian diet, increased intake of plant oils and fatty fish rich in omega-3 fatty acids, and ample antioxidant supply. This diet also is effective in preventing cardio-vascular diseases, which occur twice as frequently in patients with inflammatory rheumatic diseases compared to healthy controls. Nutrition always must be regarded an adjuvant therapy, becoming effective on inflammation only 3 months after initiation, and only thereafter anti-inflammatory drugs may be reduced or stopped, according to medical advice. Dietary therapy is complex in rheumatic diseases, as frequent co-morbidities, e. g. osteoporosis, intolerances of or sensitivities to individual nutrients, and adjustment of deficient or inappropriate nutrient intake, have to be considered. To optimize the outcome, treatment should be given to the patients in a team, consisting of e. g. rheumatologist, nutritionist, physiotherapist and psychotherapist. Interactions of these specialists are crucial for the success, and are trained in special seminars.