Low Intake Levels Research Articles

Sodium Intake Recommendations: A Subject that Needs to be Reconsidered.

Hypertension affects 1 billion people worldwide and is considered the leading cause of death, stroke, myocardial infarction and congestive heart failure. Sodium intake is reported to be a modifiable determinant of hypertension and reductions in its consumption have been widely recommended. Various strategies have been proposed to address the observed epidemic of cardiovascular diseases, particularly in medium and low-income countries. Among these strategies, reducing dietary sodium intake and increasing dietary potassium intake are commonly included in guidelines for the treatment of hypertension and the prevention of cardiovascular disease. In the present article, we review the results of recent studies that have raised questions about potential adverse effects associated with low sodium intake on important health outcomes, including cardiovascular diseases and death. It is clear from these studies, that there are contradictory and irreconcilable positions in the interpretation of the evidence, a situation that indicates that there is an urgent need for international randomized controlled trials that consistently demonstrate that the low levels of sodium intake recommended in the guidelines are safe and beneficial for different populations around the world. In the interim, and in accordance with a number of experts, we agree that the current evidence argues against the reduction of dietary sodium as an isolated public health recommendation and that an alternative approach of recommending high quality, potassium rich diets, might achieve greater health benefits, including blood-pressure reduction, than aggressive sodium reduction alone.

Commodification and Westernization: Explaining Declining Nutritional Intake in Contemporary Rural China

Despite China's rapid growth in the past decade, Chinese rural residents suffer from a continuing decline of both calorie and protein intakes. We investigate the dramatic historical changes in nutritional intake in the Chinese countryside. There are two main explanations for the decline: first, the changing demographic and economic structure contributes to a lower demand for energy compared to traditional rural society; and, second, the rising cost of non‐food essential goods could lead to a squeeze in the food budget. Using both national‐level and provincial‐level data, we find evidence for both factors. We further argue that the current abnormally low level of nutritional intake is mainly due to commodification in the context of diet westernization. Rural residents' nutritional intake declines as they divert their consumption from relatively cheap sources of energy (grain and vegetable) to more expensive alternatives (meat and poultry) under a squeezed budget. The shocking failure of sustaining a healthy rural population is a unique manifestation of the contradiction in the Chinese agrarian relations.

Evaluation of dietary behavior and nutrient intake in patients with Tourette Syndrome

AbstractThis study is aim to know the dietary behaviour, food variety and nutrients intake in patients with Tourette Syndrome. Forty‐eight patients with TS were enrolled in this survey. Their dietary intake within 24 hours and dietary behaviors were surveyed and analyzed. In the respect of dietary behavior, 87.50% patients had three meals every day and 87.50% patients had four meals every day, 60.00% patients liked snacks, and 55.36% patients ingested less food owing to snacks. The total energy intake of the patients was low compared to the energy recommended. 52.25% TS patients had low levels of protein intake compared to recommended nutrient intake. And the ratio of carbohydrate and fat were inappropriate. The intake of calcium, zinc, retinal, thiamine, riboflavin and vitamin C were low compared with the intake recommended by the Chinese Nutrition Society, and their NAR were 0.37, 0.71, 0.68, 0.78, 0.67 and 0.78 respectively. The vitamin E was high compared with the intake recommended by the Chinese Nutrition Society, and their NAR was 1.23. The mean of DDS was (5.21±1.18). These results indicated that patients with TS had some bad dietary behaviour needed to abandon. The nutritional intake of patients with TS was unbalanced.Nutritional dietary guildline based on TS patients should be formulated and the guardian of TS patients offer balanced diet in order to ensure TS patients get adequate nutrition.

Inaccuracy of Self-reported Low Sodium Diet among Chinese: Findings from Baseline Survey for Shandong & Ministry of Health Action on Salt and Hypertension (SMASH) Project

This study was aimed to evaluate the agreement between the self-reported sodium intake level and 24-h urine sodium excretion level in Chinese. The 24-h urine collection was conducted among 2112 adults aged 18-69 years randomly selected in Shandong Province, China. The subjects were asked whether their sodium intake was low, moderate, or high. The weighted kappa statistics was calculated to assess the agreement between 24-h urine sodium excretion level and self-reported sodium intake level. One third of the subjects reported low sodium intake level. About 70% of the subjects had mean 24-h sodium excretion>9 g/d, but reported low or moderate sodium intake. The agreement between self-reported sodium intake level and 24-h urine sodium excretion level was low in both normotensive subjects and hypertensive subjects. These findings suggested that many subjects who reported low sodium intake had actual urine sodium excretion>9 g/d. Sodium intake is often underestimated in both hypertensive and normotensive participants in China.

Depression and Cognitive Impairment Are Associated with Low Education and Literacy Status and Smoking but Not Caffeine Consumption in Urban African Americans and White Adults.

Background: Recent research has linked caffeine consumption with a lower risk for depression and cognitive decline. However, no studies have examined the relationship in an African American compared to a white, socioeconomically diverse representative urban sample. Methods: Data from a cross-sectional study were used to determine the associations of caffeine use with depressive symptomatology and cognition in a sample of 1,724 participants in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. The United States Department of Agriculture's Automated Multiple Pass Method was used by trained interviewers to collect two, in-person 24-hour dietary recalls. Depressive symptoms and global cognition were assessed using two well-validated measures: the Center for Epidemiologic Studies Depressive Scale (CES-D) and Mini Mental State Examination (MMSE), respectively. Usual caffeine intake was based on both recalls. Data were analyzed with t- and chi-square tests, correlation analysis, and ordinal logistic regression. Results: African Americans consumed significantly less caffeine than did whites (89.0±3.2 and 244.0±8.7 mg respectively). Caffeine consumption was not associated with depressive symptomatology or global cognition. Age, less than 5th grade literacy, and less than high school education were significantly associated with both depressive symptoms and cognitive function. Smokers had a 43% greater risk for depression but only a 3% higher risk for cognitive impairment. Conclusion: The low level of dietary caffeine intake in combination with smoking among HANDLS study participants may have influenced the lack of association with depressive symptomatology or global cognition. For this sample, low literacy and education appear more highly associated with depressive symptoms and cognitive function than caffeine intake.

Dietary intake of energy, nutrients and water in elderly people living at home or in nursing home.

There is a lack of detailed information on dietary intake in elderly people at an individual level, which is crucial for improvement of nutritional support. The aim of this study was to investigate the dietary intake in elderly people in two types of living situations. Observational study, analysing prospective data. The dietary intake was studied in elderly people living at home or in nursing home, in different cities of Sweden. A total of 264 elderly people (mean age 84) participated in the observational study. Dietary intake was measured using weighed food records and food diaries, comparing females and males. The observed dietary intake was related to Recommended intake and Lower intake level. All dietary intake and patient characteristic variables showed large individual differences (ranges). We found no significant differences (p>0.05) between those living at home and nursing home residents regarding the average intake of energy, protein and water when expressed as total intake per kg of body weight. A very low daily intake of energy (<20 kcal/kg body weight/day) was observed in 16% of the participants. For vitamin D and iron, 19% and 15%, respectively, had intakes below the Lower intake level. There was no correlation between intake of energy, protein or water and resident characteristics such as age, autonomy, morbidity, nutritional state or cognition. The large individual differences (ranges) in energy, nutrients and water show that the use of mean values when analysing dietary intake data from elderly people is misleading. From a clinical perspective it is more important to consider the individual intake of energy, nutrients and water. Ageism is intrinsic in the realm of 'averageology'.

Interactions between cocoa flavanols and inorganic nitrate: Additive effects on endothelial function at achievable dietary amounts

Dietary intervention studies have shown that flavanols and inorganic nitrate can improve vascular function, suggesting that these two bioactives may be responsible for beneficial health effects of diets rich in fruits and vegetables. We aimed to study interactions between cocoa flavanols (CF) and nitrate, focusing on absorption, bioavailability, excretion, and efficacy to increase endothelial function. In a double-blind randomized, dose–response crossover study, flow-mediated dilation (FMD) was measured in 15 healthy subjects before and at 1, 2, 3, and 4h after consumption of CF (1.4–10.9mg/kg bw) or nitrate (0.1–10mg/kg bw). To study flavanol–nitrate interactions, an additional intervention trial was performed with nitrate and CF taken in sequence at low and high amounts. FMD was measured before (0h) and at 1h after ingestion of nitrate (3 or 8.5mg/kg bw) or water. Then subjects received a CF drink (2.7 or 10.9mg/kg bw) or a micro- and macronutrient-matched CF-free drink. FMD was measured at 1, 2, and 4h thereafter. Blood and urine samples were collected and assessed for CF and nitric oxide (NO) metabolites with HPLC and gas-phase reductive chemiluminescence. Finally, intragastric formation of NO after CF and nitrate consumption was investigated. Both CF and nitrate induced similar intake-dependent increases in FMD. Maximal values were achieved at 1h postingestion and gradually decreased to reach baseline values at 4h. These effects were additive at low intake levels, whereas CF did not further increase FMD after high nitrate intake. Nitrate did not affect flavanol absorption, bioavailability, or excretion, but CF enhanced nitrate-related gastric NO formation and attenuated the increase in plasma nitrite after nitrate intake. Both flavanols and inorganic nitrate can improve endothelial function in healthy subjects at intake amounts that are achievable with a normal diet. Even low dietary intake of these bioactives may exert relevant effects on endothelial function when ingested together.

Potential Association of Urinary N7-(2-Carbamoyl-2-hydroxyethyl) Guanine with Dietary Acrylamide Intake of Smokers and Nonsmokers.

Acrylamide (AA), a rodent carcinogen, is widely used in industry and present in cigarette smoke as well as in foods processed at high temperatures. The metabolic activation of AA to glycidamide (GA) could be critical for AA carcinogenicity since GA causes DNA adduct formation in vivo. N7-(2-carbamoyl-2-hydroxyethyl) guanine (N7-GAG), the most abundant DNA adduct of AA, is subjected to spontaneous and enzymatic depurination and excreted through urine. Urinary N7-GAG analysis can confirm AA genotoxicity and identify active species of AA metabolites in humans, thereby serving as a risk-associated biomarker for molecular epidemiology studies. This study aimed to develop an isotope-dilution solid-phase extraction liquid chromatography tandem mass spectrometry method to comparatively analyze urinary N7-GAG levels in nonsmokers and smokers. Urinary N-acetyl-S-(propionamide)-cysteine (AAMA), a metabolite of AA, was also analyzed as a biomarker for current AA exposure. Urinary N7-GAG was quantified by monitoring m/z 239 → 152 for N7-GAG and m/z 242 → 152 for (13)C3-labeled N7-GAG under positive electron spray ionization and multiple reaction mode. The median urinary N7-GAG level was 0.93 μg/g creatinine in nonsmokers (n = 33) and 1.41 μg/g creatinine in smokers (n = 30). Multiple linear regression analysis of data revealed that N7-GAG levels were only significantly associated with AAMA levels. These results demonstrate that urinary N7-GAG of nonsmokers and smokers is significantly associated with a very low level of dietary AA intake, assessed by analyzing urinary AAMA.

‘Why take chances?’ Advice on alcohol intake to pregnant and non-pregnant women in four Nordic countries

In this article we explore the construction of risk in government guidelines on alcohol intake during and before pregnancy in four Nordic countries given that there is no sound evidence linking a low level of alcohol intake during pregnancy to foetal harm. In the article we draw on two sources of data to examine the rationale behind the advice given to pregnant women: health education materials and other government documents, such as guidelines for professionals. We found that in all the four countries the government guidelines advised pregnant women to completely abstain from alcohol consumption, but there was some variation between the countries in the advice for non-pregnant women. The guidance in the four countries also differed in the extent to which they discussed the lack of evidence behind the abstinence advice and the precautionary approach on which the advice was based. In all the four countries the printed and widely circulated health education materials did not explain that the abstinence advice was not based on actual evidence of harm but on a precautionary approach. The other government documents adopted varying strategies for justifying the abstinence advice including not offering information about the uncertainty of the knowledge base, implying that there was evidence that low alcohol consumption was harmful to the foetus, acknowledging that a safe level of alcohol intake during pregnancy could not be specified and explaining the precautionary approach to risk. In this article we argue that the shift from ‘estimation of risk’ to the ‘precautionary principle’ is a part of a wider socio-cultural push towards broader employment of the precautionary principle as a strategy to manage uncertainty, and in the context of pregnancy, it is a part of the symbolic struggle to protect the purity of the foetus and construct the ‘perfect mother’.

Intervention use and action planning in a web-based computer-tailored weight management program for overweight adults: randomized controlled trial.

BackgroundThere are many online interventions aiming for health behavior change but it is unclear how such interventions and specific planning tools are being used.ObjectiveThe aim of this study is to identify which user characteristics were associated with use of an online, computer-tailored self-regulation intervention aimed at prevention of weight gain; and to examine the quality of the goals and action plans that were generated using the online planning tools.MethodsData were obtained with a randomized controlled effect evaluation trial in which the online computer-tailored intervention was compared to a website containing generic information about prevention of weight gain. The tailored intervention included self-regulation techniques such as personalized feedback, goal setting, action planning, monitoring, and other techniques aimed at weight management. Participants included 539 overweight adults (mean age 46.9 years, mean body mass index [BMI] 28.03 kg/m2, 31.2% male, 11% low education level) recruited from the general population. Use of the intervention and its planning tools were derived from server registration data. Physical activity, fat intake, motivational factors, and self-regulation skills were self-reported at baseline. Descriptive analyses and logistic regression analyses were used to analyze the results.ResultsUse of the tailored intervention decreased sharply after the first modules. Visiting the first tailored intervention module was more likely among participants with low levels of fat intake (OR 0.77, 95% CI 0.62-0.95) or planning for change in PA (OR 0.23, 95% CI 0.05-0.97). Revisiting the intervention was more likely among participants high in restrained eating (OR 2.45, 95% CI 1.12-5.43) or low in proactive coping skills for weight control (OR 0.28, 95% CI 0.10-0.76). The planning tools were used by 5%-55% of the participants, but only 20%-75% of the plans were of good quality.ConclusionsThis study showed that psychological factors such as self-regulation skills and action planning were associated with repeated use of an online, computer-tailored self-regulation intervention aimed at prevention of weight gain among adults being overweight. Use of the intervention was not optimal, with a limited number of participants who visited all the intervention modules. The use of the action and coping planning components of the intervention was mediocre and the quality of the generated plans was low, especially for the coping plans. It is important to identify how the use of action planning and coping planning components in online interventions can be promoted and how the quality of plans generated through these tools can be improved.Trial RegistrationNetherlands Trial Register: NTR1862; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1862 (Archived by WebCite at http://www.webcitation.org/6QG1ZPIzZ).

Maternal urinary iodine concentration in pregnancy and children's cognition: results from a population-based birth cohort in an iodine-sufficient area

ObjectiveReports from populations with an insufficient iodine intake suggest that children of mothers with mild iodine deficiency during pregnancy are at risk for cognitive impairments. However, it is unknown whether,...

Alcohol Consumption Over Time and Risk of Death: A Systematic Review and Meta-Analysis

The results from the few cohort studies that have measured usual alcohol consumption over time have not been summarized. We therefore conducted a systematic review and meta-analysis to quantify mortality risk. Pertinent studies were identified by searching the Medline, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, and Scopus databases through August 2012 using broad search criteria. Studies reporting relative mortality risks for quantitatively defined categories of alcohol consumption over time were eligible. Nine cohort studies published during 1991-2010 (comprising 62,950 participants and 10,490 deaths) met the inclusion criteria. For men, there was weak evidence of lower mortality risk with low levels of alcohol intake over time but higher mortality risk for those with intakes over 40 g/day compared with abstainers using a random-effects model (P for nonlinearity = 0.02). The pooled relative risks were 0.90 (95% confidence interval: 0.81, 0.99) for 1-29 g/day, 1.19 (95% confidence interval: 0.89, 1.58) for 30-59 g/day, and 1.52 (95% confidence interval: 0.78, 2.98) for 60 or more g/day compared with abstention. There was moderate between-study heterogeneity but no evidence of publication bias. Studies including women were extremely scarce. Our findings include a curvilinear association between drinking over time and mortality risk for men overall and widespread disparity in methods used to capture exposure and report results.

ALSPAC Mercury Study and Fish Consumers

Golding et al. (2013) described regression analysis of dietary contributions to maternal blood mercury levels, nested within the Avon Longitudinal Study of Parents and Children (ALSPAC). Fish intake explained only about 7% of the variance in blood mercury, leading them to conclude somewhat cautiously that “limiting seafood intake during pregnancy may have a limited impact on prenatal blood mercury levels” (Golding et al. 2013). The media, however, has been quick to overinterpret the results, and Golding herself was quoted: We were pleasantly surprised to find that fish contributes such a small amount … to blood mercury levels…. We hope many more women will now consider eating more fish during pregnancy. (ALSPAC 2013) This is a much less cautious conclusion. ALSPAC and Golding are responsible for many valuable publications on human development, but ALSPAC was not designed to investigate mercury exposure and effects. The categories of white fish, oily fish, and shellfish used by Golding et al. (2013) do not meaningfully reflect mercury content. With respect to the internal validity of the exposure estimate from the dietary questionnaire, high-mercury and low-mercury fish are represented among both the “white” and “oily” categories, and shellfish generally have very little mercury. Thus, internal validity is limited by a poor exposure metric. External validity is more of a problem. The results of Golding et al. (2013) are not generalizable to the frequent consumers of fish who are most vulnerable to methylmercury exposure from fish during pregnancy. Women who ate fish frequently (> 3 times/week) made up 5.8 µg/L, the level corresponding to the U.S. Environmental Protection Agency (EPA) methylmercury reference dose of 0.1 µg/kg/day (U.S. EPA 2013). Although frequent fish consumers are a small part of the general population and the ALSPAC study, they are the population at risk for methylmercury exposure, particularly during pregnancy. Frequent fish consumers should reduce frequency or size of fish meals or choose among the many types of fish low in mercury. The mercury in fish is predominantly methylmercury, and for most people, fish is the only significant source of methylmercury (Bjornberg et al. 2005; Mahaffey et al. 2004). Methylmercury is the toxic form that is almost 100% absorbed from the gut, and it is readily translocated to both the brain and the fetus. This is the reason for public health concern regarding consumption of high-mercury fish by frequent fish-eaters. At low levels of fish intake, other, nonorganic forms and pathways influence blood mercury levels. The results of Golding et al. (2013) suggest that women who rarely eat fish and already have a low blood mercury concentration will not further lower the mercury by eating even less fish. The study, however, did not address the risk for the frequent fish-eater who has elevated blood mercury. It is not clear whether the developmental benefits ascribed to eating fish are due to its nutrients or to the healthy lifestyles that often correlate with eating fish frequently. We conclude that women who eat fish rarely or never may benefit both self and fetus by eating fish occasionally. Pregnant women should choose low-mercury fish species, particularly if they eat fish frequently (more than twice a week).

Deconstructing Supermarket Intervention Effects on Fruit and Vegetable Consumption in Areas of Limited Retail Access: Evidence from the Seacroft Study

Concern about diet and access to healthy foodstuffs is felt worldwide. The introduction of large retailers, with low prices and wide product ranges, to poor access areas has been seen as a solution. We apply quantile regression to data related to one such opening, the Seacroft Intervention Study in the United Kingdom, allowing consideration at different levels of the fruit and vegetable consumption distribution. For residents with easy access to the new store, captured using Ordnance Survey Integrated Transport Network for improved representation of shoppers' journeys, a significant average increase of half a portion per day was found, increasing to 0.7 portions or more for households with no car access. However moving away from the average effects considered in the literature thus far, shopping at the new store is significant only for those at the top end of the distribution and, importantly, not for those whose diets were previously poor. Attitudes to healthy eating, relative cost of fruit and vegetables, and deprivation are shown to be key factors at lower intake levels. Access remains a significant determinant of consumption. Hence we urge caution in accepting the conclusion that new supermarkets can benefit all, and suggest that policy makers should consider more targeted measures to help improve the worst diets.

Maternal backfat depth in gestating sows has a greater influence on offspring growth and carcass lean yield than maternal feed allocation during gestation

A commercial pig spends nearly half of its life in utero and its nutrition during this time can influence birth weight and postnatal growth. We hypothesised that postnatal growth is increased in pigs raised by sows with a high backfat depth and high level of energy intake during gestation compared with sows with a low backfat depth and low level of energy intake during gestation. This was tested in a 2×3 factorial design experiment with 2 factors for gilt backfat depth (Thin and Fat) and 3 factors for gestation feed allowance (Restricted, Control and High). Between d 25 and d 90 of gestation, Thin gilts (n=68; 12±0.6 mm P2 backfat) and Fat gilts (n=72; 19±0.6 mm P2 backfat) were randomly allocated, as individuals, to a gestation diet (6.19 g/kg lysine, 13.0 MJ DE/kg) at the following feed allowances: 1.8 kg/day (Restricted); 2.5 kg/day (Control) and 3.5 kg/day (High). For the remainder of gestation and during lactation all gilts were treated similarly. At weaning (day 28), 155 piglets were sacrificed and 272 were individually housed and followed through to slaughter (day 158). At day 80 of gestation, fasted Thin Restricted gilts had lower serum IGF-1 concentrations than Thin High or Thin Control fed gilts (P<0.001). Pigs born from Fat gilts had greater backfat depths (P<0.05), a lower lean meat yield (P<0.05) and were heavier (P<0.05) at slaughter than pigs born from Thin gilts. Gilt gestation feed allowance had only transitory effects on average daily gain and feed conversion efficiency and had no effect on pig weight at slaughter (P>0.05) or lean meat yield (P>0.05). In conclusion, gilts with a backfat depth of ~19 mm at insemination produced pigs that were heavier and fatter at ~158 days of age than those born from gilts with ~12 mm backfat depth at insemination. Maternal body condition during gestation had a more predominant influence on growth parameters of the offspring, such as weight at slaughter and backfat depth, than did feed level during gestation.

Effects of Corn Naturally Contaminated with Aflatoxins on Performance, Calcium and Phosphorus Metabolism, and Bone Mineralization of Broiler Chicks

The objective of this study was to investigate the effects of corn naturally contaminated with low levels of aflatoxins (AF) on performance, calcium (Ca) and phosphorus (P) metabolism, and bone mineralization in broilers. Four hundred and fifty 1-d-old male broiler chicks were randomly allotted to control (no AF), and the diet with the corn contaminated with AF as a substitute for 50% or 100% of the corn in control (HAC or AAC). The broilers in HAC and AAC were administered with 6.5-8.0 and 13.0-16.0 μg AF/kg BW per day respectively in overall period (1-42 d). Ten birds per treatment were selected at d 43 to explore the apparent digestibility of Ca and P using all excreta collection method after 2 days adaptation. The AAC diet reduced (P<0.05) the performance of birds in overall period, whereas the HAC diet temporarily decreased (P<0.05) the performance of birds in starter phase (1-21 d). The corn contaminated with AF had no effect (P>0.24) on the apparent digestibility of Ca and P. The increasing AF intake content linearly increased (P<0.001) serum parathyroid hormone (PTH) level, and decreased (P<0.05) serum 1,25-dihydroxychocalciferol and P concentrations on d 42. On d 21, the AAC diet reduced (P<0.05) tibia breaking strength (TBS) when compared to control or HAC group, however, it did not affect (P>0.10) the percentages of ash, Ca and P in tibia. On d 42, the increasing AF intake level linearly decreased (P<0.05) TBS, and the percentages of Ca and P in tibia. These results indicated that the low level of AF intake had negative effects on the P metabolism and bone mineralization of broilers at exposure of 42 days, which might relate to the changes in vitamin D and PTH metabolism.

Sleep duration and energy intake in female gymnasts from preparatory training period to competition season

Sleep and energy intake can maximize the benefits of training process during the athletic season. Only an adequate amount of sleep and a balanced diet can promote an optimal athletic performance. Although gymnasts seem to be at a low level of energy intake and suffer from insufficient sleep, few investigations have examined this concern, especially in female athletes. The main purpose of this study was to evaluate the amount of sleep and energy intake from the preparatory period to the competition period of an athletic season. 70 competition female gymnasts (11.1 ± 2.8 years old; 35.8 ± 10.4 Kg; 140.4 ± 13.6 m) taking part in the Portuguese Gymnastic Federation were evaluated by a questionnaire, which collected: training data; number of sleep hours in weekdays and weekend days; energy and nutrients intake by a three days consecutive food record and; anthropometric measures (weight, height and body mass index). Descriptive linear regression analysis and Pearson correlation coefficients were used. The significance level was 5%. Data was analyzed using SPSS, version 18.0. Gymnasts slept more in the weekend days than in weekdays during the athletic season, but sleep duration decreased from the preparatory period (8.5 ± 1.4 h/day) to the competitive period (8.0 ± 0.6 h/day). Gymnasts’ energy intake decreased from preparatory periods (1603 ± 487 Kcal/day) to competitive period (1400 ± 461 Kcal/day). Gymnasts’ height and weight increased among the season. Gymnasts presented an insufficient sleep duration for their age and physical requirements and an unbalance and hypo caloric diet, which can compromise their athletic performance and efficiency.

Antioxidant vitamins in the context of nonalcoholic fatty liver disease in obese children and adolescents

OBJECTIVE: To review the literature on the importance of antioxidant vitamins, analyzed in the context of dietary intake, its plasma levels, and its current use as a supplementation treatment in obese children and adolescents with nonalcoholic fatty liver disease. DATA SOURCES: The articles were identified in Lilacs, Ibecs, SciELO, PubMed/Medline, and Scopus databases. To conduct the survey, the "fatty liver" descriptor was associated to the following words: "children", "antioxidants" and "vitamins". The search was limited to articles written in Portuguese, Spanish and English, with publication date until December, 2012. DATA SYNTHESIS: Six studies were selected. The survey revealed a low dietary intake and low antioxidant vitamins serum levels in this population. The changes in lifestyle, with adequate dietary intake of vitamins, and the increase in physical activity were associated with a significant improvement in liver histology and in laboratory tests. Vitamin supplementation also improved the disease progression markers, as the alanine aminotransferase serum levels and the histological characteristics of lobular inflammation and hepatocellular damage. However, these improvements were not statistically significant in all studies. CONCLUSIONS: There is insufficient evidence to recommend or to refute antioxidant supplementation in patients with simple steatosis or steatohepatitis. The changes in lifestyle seem to be, at the present time, the more advisable therapy.

Food Intake and the Risk of Endometrial Endometrioid Adenocarcinoma in Japanese Women

The present study examined the association between food intake and endometrial cancer restricted to endometrial endometrioid adenocarcinoma (EEA) using a case-control study in Japanese women. One hundred sixty-one cases and 380 controls who completed a questionnaire regarding demographic, lifestyle, and food frequency questionnaire were analyzed. Odds ratio (OR) between selected food intakes and EEA were calculated by logistic regression analysis. After adjustment putative confounding factors, the higher intakes of vegetables [odds ratio (OR) = 0.47, 95% confidence interval (CI) = 0.26–0.83], peanuts (OR = 0.48, CI = 0.27–0.86), fish (OR = 0.52, CI = 0.29–0.93), boiled egg (OR = 0.24, CI = 0.33–0.92), instant noodles (OR = 1.94, CI = 1.12–3.34), instant food items (OR = 2.21, CI = 1.31–3.74), and deep-fried foods (OR = 2.87, CI = 1.58–5.21) were associated with a risk for EEA. The inverse association with a risk of EEA was also seen in higher intakes (g/1000 kcal) for vegetables (0.45, CI = 0.25–0.81) and fish (0.53, CI = 0.30–0.94) as compare to lower intake. Higher intake of vegetables, peanuts, fish, and boiled egg was associated with a reduced risk for EEA, whereas instant noodles, instant food items, and deep-fried foods was associated with an increased risk for EAA as compared to lower levels of intake.

The IOM Report Fails To Detect Evidence to Support Dietary Sodium Guidelines

The recent Institute of Medicine (IOM) report “Sodium intake in populations: Assessment of Evidence”1 has provided critical information concerning the dietary sodium guidelines currently recommended by agencies of the US government.2 The American Journal of Hypertension has assembled a set of commentaries providing the range of official and independent views addressing how the IOM report will (or should) influence dietary sodium policy and practice.3–7 Our purpose is to provide a concise and comprehensive assessment of how things stand in the immediate aftermath of the IOM report. Our hope is that these manuscripts will further inform what promises to be a lively public and scientific debate about the implications of the IOM report. The balanced review and analysis has the credibility to make this report a paradigm shifting publication. The hypothesis from which sodium guidelines emerged i.e., that because reduced sodium intake lowered blood pressure, it would inevitably prevent cardiovascular morbidity and mortality – has failed to find support in the IOM report. The Committee found that the modest blood pressure effect is not a certain surrogate for health outcomes associated with sodium intake. Instead, the Committee’s case rested upon evidence of actual health consequences associated with reducing sodium intake from the current average of 3,400 mgs/day, to 5,000 mgs) of sodium to all lower intake levels. Third, based upon the large body of mostly observational data reported over the past 8 years, it found that a possibility of harm existed at the lower (<2,300 mgs) end, and more confidently, at the higher (unspecified other than as “excessive”) end as well. This implies that a “safe” range for sodium exists. Fourth, the committee specifically declined to identify any “target” for sodium intake, or a safe range of intakes consistent with optimal human health. Fifth, the committee found insufficient evidence of either harm or benefit from sodium consumption below 2,300 mgs, and cautioned against intakes <1,500 mgs/day. Sixth, and finally, the report specifically failed to find evidence to support current guidelines promoted by both the US Centers for Disease Control and Prevention (CDC) and the New York City Department of Health. Given the prominent role played by the CDC and the New York City Department of Health in promoting current guidelines, the directors of both have been invited to respond to the IOM report.3,4 While all submissions have been subject to peer review, wide latitude has been afforded authors. Investigators who have contributed important data on both sides of the current controversy have also been invited to submit their views.5,6 In addition, a report describing sodium intake in much of the world over the past half century provides critical background for examining the sodium issue.7 And, finally, a distinguished scholar of nutrition and nutrition policy has described how nutrient guidelines have and can be reached, and describes a method, based upon pathophysiology, and consistent with clinical outcomes, for defining a safe range for sodium intake.8