Nutritional Consequences Research Articles

Impact of human milk pasteurization on the kinetics of peptide release during in vitro dynamic term newborn digestion.

Holder pasteurization (62.5°C, 30 min) ensures sanitary quality of donor's human milk but also denatures beneficial proteins. Understanding whether this further impacts the kinetics of peptide release during gastrointestinal digestion of human milk was the aim of the present paper. Mature raw (RHM) or pasteurized (PHM) human milk were digested (RHM, n = 2; PHM, n = 3) by an in vitro dynamic system (term stage). Label-free quantitative peptidomics was performed on milk and digesta (ten time points). Ascending hierarchical clustering was conducted on "Pasteurization × Digestion time" interaction coefficients. Preproteolysis occurred in human milk (159 unique peptides; RHM: 91, PHM: 151), mostly on β-casein (88% of the endogenous peptides). The predicted cleavage number increased with pasteurization, potentially through plasmin activation (plasmin cleavages: RHM, 53; PHM, 76). During digestion, eight clusters resumed 1054 peptides from RHM and PHM, originating for 49% of them from β-casein. For seven clusters (57% of peptides), the kinetics of peptide release differed between RHM and PHM. The parent protein was significantly linked to the clustering (p-value = 1.4 E-09), with β-casein and lactoferrin associated to clusters in an opposite manner. Pasteurization impacted selectively gastric and intestinal kinetics of peptide release in term newborns, which may have further nutritional consequences.

Review of randomized controlled trials of nutritional supplementation in people living with HIV

Review of randomized controlled trials of nutritional supplementation in people living with HIV Alicia Sneij, Adriana Campa, Marianna K Baum Stempel College of Public Health and Social Work, Florida International University, Modesto Maidique Campus, Miami, FL, USA Background: Nutritional deficiencies are widespread in people living with HIV (PLWH), prior to the antiretroviral treatment (ART). Nutrient deficiencies and other nutrition-related conditions, however, have been identified in patients receiving ART. Trials of nutritional supplementation have been conducted to alleviate these nutritional conditions and improve or reverse nutrition-related outcomes. This review aims to evaluate the benefits of supplementation, its unintended adverse effects, and the difference in approach and focus, research design, formulations, and outcomes between those randomized clinical trials (RCTs) conducted before and after the initiation of ART. Methods: An evidence-based systematic review of the literature was conducted using electronic databases and the resources of the Florida International University Research Library. Forty-two RCTs were selected for review, and their design and outcomes were compared and contrasted conceptually and in the form of tables. Results: Most of the RCTs (n=31) were conducted before the advent of ART, and their aims were delaying disease progression, reversing malnutrition, and improving pregnancy outcomes in women and infants infected with HIV. The RCTs conducted with coadministration of ART were fewer (n=11), with relative smaller sample size, of shorter duration, and mainly focused on preventing or ameliorating the nutrition-related conditions generated by the chronic infection, its treatment, and the aging of PLWH. Conclusion: As ART is becoming more accessible worldwide, and people are living longer with the disease, more longitudinal trials of nutritional interventions with larger sample sizes are needed to study the nutritional consequences and potential treatments for PLWH. Keywords: HIV, antiretroviral therapy, micronutrients, probiotics, AIDS, randomization, clinical trial

Effects of quebracho tannin extract on rumen fermentation and yield and composition of microbial mass in heifers.

To determine the effects of incremental quebracho tannin extract (QTE) infusions on rumen fermentation and yield and composition of microbial mass, a study was conducted that consisted of 1 control period (Control I) without QTE dosing; 4 periods when all animals received 1, 2, 4, or 6% QTE of the diet (DM basis); and a second control period (Control II). Each period consisted of 9 d of adaptation, 6 d of urine collection, and 1 d of rumen sampling. Three rumen-fistulated heifers (495 kg BW [SE 14]) were offered 2.6 kg/d grass hay, 2.6 kg/d concentrates, and 60 g/d mineral-vitamin premix (as fed) in 2 equal meals. Half the daily QTE dosage was intraruminally administered at every meal. Urine and rumen fluids were analyzed for purine derivatives and short-chain fatty acids, respectively. Nitrogen and purine base (PB) concentrations were determined in liquid-associated microbes in rumen fluid (LAMF), liquid-associated microbes in the solid phase (LAMS), and particle-associated microbes (PAM). Increasing QTE dosages linearly increased propionate and butyrate proportions in rumen fluid ( = 0.37, = 0.004 and = 0.51, < 0.001, respectively). Instead, proportions of acetate ( = 0.75, < 0.001), isobutyrate ( = 0.66, < 0.001), and isovalerate ( = 0.49, < 0.001) and urinary purine derivatives excretions ( = 0.66, < 0.001) linearly decreased with increasing QTE infusions. Inconsistent differences were observed for LAMF, but concentrations of PB in LAMS ( ≤ 0.018) and of N in PAM ( < 0.001) were greater at 6% QTE than at Control I, II, and 1% QTE. Hence, low to moderate QTE dosages hamper rumen fermentation and microbial biomass yields. Alongside the nutritional consequences for the host, the methodological implications of these effects should be considered in studies evaluating the targeted use of tannins in ruminant feeding.

KNOWLEDGE AND BEHAVIORS SURROUNDING A GLUTEN‐FREE DIET BETWEEN MEDICALLY AND SELF‐DIAGNOSED INDIVIDUALS

KNOWLEDGE AND BEHAVIORS SURROUNDING A GLUTEN‐FREE DIET BETWEEN MEDICALLY AND SELF‐DIAGNOSED INDIVIDUALS

Food environments of young people: linking individual behaviour to environmental context.

We aimed to identify and characterize the food environments from which young people obtain food and to explore associations between the type of food environment and food intakes. Young people (n = 86, mean age 17 years; combined data of two sequential pilot studies (collected in 2008-09) and a study conducted in 2011-12) recorded in 4-day self-complete food diaries what food they consumed and where food was sourced. Nutrient, fruit and vegetable intake was calculated according to the source of food, categorized using a food environment classification tool. Over 4 days, respondents sourced food from an average of 4.3 different food environments. Home food was used daily and was more favourable in terms of nutrient profile than out-of-home food. Food sourced from specialist outlets, convenience stores and retail bakers had the highest energy density. Food from retail bakers and 'takeaway and fast food' outlets were the richest sources of fat while vending machines and convenience stores had the highest percentage of energy from sugar. This work provides details of 'where' young people obtain food and the nutritional consequences of choosing those food environments. While home food was a significant contributor to total dietary intake, food was obtained from a broad range of environments; particularly takeaway, fast food and education establishments.

Insights on Alterations to the Rumen Ecosystem by Nitrate and Nitrocompounds.

Nitrate and certain short chain nitrocompounds and nitro-oxy compounds are being investigated as dietary supplements to reduce economic and environmental costs associated with ruminal methane emissions. Thermodynamically, nitrate is a preferred electron acceptor in the rumen that consumes electrons at the expense of methanogenesis during dissimilatory reduction to an intermediate, nitrite, which is primarily reduced to ammonia although small quantities of nitrous oxide may also be produced. Short chain nitrocompounds act as direct inhibitors of methanogenic bacteria although certain of these compounds may also consume electrons at the expense of methanogenesis and are effective inhibitors of important foodborne pathogens. Microbial and nutritional consequences of incorporating nitrate into ruminant diets typically results in increased acetate production. Unlike most other methane-inhibiting supplements, nitrate decreases or has no effect on propionate production. The type of nitrate salt added influences rates of nitrate reduction, rates of nitrite accumulation and efficacy of methane reduction, with sodium and potassium salts being more potent than calcium nitrate salts. Digestive consequences of adding nitrocompounds to ruminant diets are more variable and may in some cases increase propionate production. Concerns about the toxicity of nitrate's intermediate product, nitrite, to ruminants necessitate management, as animal poisoning may occur via methemoglobinemia. Certain of the naturally occurring nitrocompounds, such as 3-nitro-1-propionate or 3-nitro-1-propanol also cause poisoning but via inhibition of succinate dehydrogenase. Typical risk management procedures to avoid nitrite toxicity involve gradually adapting the animals to higher concentrations of nitrate and nitrite, which could possibly be used with the nitrocompounds as well. A number of organisms responsible for nitrate metabolism in the rumen have been characterized. To date a single rumen bacterium is identified as contributing appreciably to nitrocompound metabolism. Appropriate doses of the nitrocompounds and nitrate, singly or in combination with probiotic bacteria selected for nitrite and nitrocompound detoxification activity promise to alleviate risks of toxicity. Further studies are needed to more clearly define benefits and risk of these technologies to make them saleable for livestock producers.

Nutritional consequences of long-term acid suppression; are they clinically important?

As acid suppression therapies with proton pump inhibitors are an extremely common practice for common acid-related diseases, there has been increased scrutiny on the safety of this class of therapy. There have been increasing reports of allegation of harm with the sustained use of proton pump inhibitors, in particular with potential adverse effects on vitamin and mineral absorption. This has prompted a number of product label changes directed by the US Food and Drug Administration, raising concerns for ongoing continued use among clinicians and patients. This review highlights the most recent information around these controversies and provides evidence summaries to help guide care providers in their care plans as well as discussions with patients.

Implementation of protected mealtimes in the subacute setting: stepped wedge cluster trial protocol.

This protocol paper describes a study that aims to determine if protected mealtimes implementation closes the energy deficit of 1900kJ between estimated requirements and actual energy intake of hospitalized adults in the subacute setting. Protected mealtimes, a strategy developed to address the prevalence of malnourished hospitalized adults, aims to minimize unavoidable and unnecessary interruptions at mealtimes. It has been implemented widely with limited high-quality studies as to its effect. A pragmatic stepped wedge cluster trial. Primary outcomes are daily energy and protein intake. Funding was awarded in October 2014. In this study, protected mealtimes implementation will occur across each cluster (ward) chosen at random. A waiver of consent has been endorsed, enabling all patients to receive the intervention. Patients excluded from outcome evaluation will be those receiving end of life care and patients who are nil by mouth. The selection of patients for outcome evaluation will also occur randomly. Sample size, randomization, statistical analysis and contamination issues consider the reporting guidelines of the CONSORT statement: extension to cluster randomized trials. The methods selected will ensure that the research is of high quality with conclusions useful and relevant for translation into practice settings. The study does not aim to assess whether the intervention is sustainable beyond the study period, rather it will establish whether the removal of known barriers to intervention uptake enables high fidelity with the intervention. As a result we will have a greater understanding of the nutritional consequences of protected mealtimes in subacute care.

One-stage conversion of Roux-en-Y gastric bypass to a modified biliopancreatic diversion with duodenal switch using a hybrid sleeve concept

BackgroundInsufficient weight loss (percentage of excess weight loss [%EWL]<50%) is observed in approximately 20% of patients after Roux-en-Y gastric bypass (RYGB). Surgical revision can be performed by various procedures including malabsorptive techniques. Conversion to a biliopancreatic diversion with duodenal switch (BPD/DS) remains a complex technique which cannot always be performed as a one-stage procedure. ObjectivesThis study evaluates the conversion of RYGB to BPD/DS using a novel gastric reconstruction technique based on a “hybrid sleeve” using the existing gastrojejunal anastomosis of the RYGB. SettingAll the procedures were performed at a private hospital. MethodsThe consecutive patients who were eligible for conversion since 2010 were reviewed; eligibility included %EWL≤50% and normal gastric pouch. The gastrojejunal anastomosis of the RYGB was untouched and the gastric fundus was resected. The gastric continuity was restored by an anastomosis between a short segment of the alimentary limb and the gastric antrum. A standard BPD/DS was then performed without restoration of the jejunal continuity. ResultsFourteen patients were converted to BPD/DS for a mean body mass index (BMI) of 44.3±6.0 kg/m2, a mean %EWL of 33.4%, and a percentage of total weight loss (%TWL) of 15.3±11.7%. The BMI before RYGB was 54.4±13.1 kg/m2, with half of the patients being super-obese. All but 3 conversions were completed as a single stage and laparoscopically in a mean of 177 minutes. The 30-day complication rate was 28.5%. No patient was lost to follow-up over a mean 25.8 months and the BMI of the 12 patients with a follow-up≥3 months is 33.2±7.2 kg/m2. With reference to the initial weight of the patients, the mean %EWL is 73.5% and %TWL is 37.6±16.0%. On average, patients benefited from a 21.1% TWL through the conversion of their RYGB. ConclusionsThis procedure allows for an easier conversion of RYGB to BPD/DS and appears to be the most effective procedure for resuming weight loss. Nutritional consequences and weight loss are similar to the primary BPD/DS results. However, the benefits and risks must be carefully assessed according to the definition of weight loss failure.

Nutritional consequences of folivory in a small-bodied lemur (Lepilemur leucopus): Effects of season and reproduction on nutrient balancing.

Small-bodied folivores are rare because processing leaves often requires extensive gut adaptations and lengthy retention times for fiber fermentation. However, the <1 kg nocturnal white-footed sportive lemurs (Lepilemur leucopus) persist on a leaf-based diet. We investigated how extrinsic (i.e., seasonality in temperature and food availability) and intrinsic factors (i.e., reproductive state) influence nutrient intake and explored how nutrient and energy needs are met in this species. We conducted full night focal follows across all seasons and analyzed nutrients in all items eaten by adults of both sexes to investigate nutrient intake and nutritional priorities in L. leucopus. We estimated digestible protein content, as this is a biologically more meaningful measure than crude protein. Protein intake was constant across seasons, while non-protein energy and dry matter intake increased from the hot wet to the cold dry season. Males and females did not differ in their nutrient or apparent energy intake irrespective of female reproductive state. We conclude that these animals prioritize protein over non-protein energy intake as dietary protein is in limited supply, and that thermoregulation poses higher energetic costs than reproduction in this species. While protein intake did not differ across female reproductive states, the relative protein content of the diet was highest during the lactation period, indicating that the balance of non-protein to protein intake may be more important than absolute intake. Dry matter intake was high compared to other folivorous primates, indicating that L. leucopus follows an intake rather than an efficiency strategy to meet its energy requirements. Am J Phys Anthropol 160:197-207, 2016. © 2016 Wiley Periodicals, Inc.

Comparative nutritional indicators as markers for resilience: the impacts of low-intensity violence among three pastoralist communities of northern Kenya

ABSTRACTWe present results from a collaborative project on the consequences of endemic violence in the pastoralist zone of Northern Kenya. Drawing on our ethnographically driven epidemiological approach, we examine the differential cost of violence by examining household nutrition. The case/control approach we employ draws data from six sites that are culturally similar but differ in the degree of exposure to, or relative insulation from, violence. As one of many lenses through which to examine the consequences of endemic violence, nutritional status offers a different story than assessing livestock holdings or access to land. Our data suggest that despite the different strategies that the pastoralist communities employ to contend with the violence, each one comes with nutritional consequences. Measuring the direct and indirect effects of violence in communities already compromised by poverty and episodic drought challenges researchers, policy-makers, and humanitarian organizations. Our goal is to offer insights into reasonable pathways for understanding these intersections of insecurity for policy and humanitarian organizations.

The Possibilities and Limits of Personal Agency

The food environment poses many challenges to low-income rural residents as they struggle to sustain themselves and their families. Rural settings in the United States are characterized by poorer food access and availability, including costlier and lower-quality produce, in comparison with urban settings. The practices employed by low-income residents to cope with these rural food environments have nutritional consequences and sometimes even broader health implications. However, these practices can also be interpreted as acts of creative agency. Using insights from earlier work on the environmental determinants of food-related behaviors, and a sociological perspective on the role of individual agency in the process of structuration, this research categorizes food-related hardships, acquisition strategies, and resources, and demonstrates how food access is negotiated within the more or less flexible constraints of rural settings characterized by the unavailability of inexpensive, high-quality foods.

Socio-Economic Characteristics of Traditional Fish Processors in Lagos State, Nigeria

The study examined the socio-economic characteristics, income and expenditure pattern among traditional fish processors in twenty different fish processing centres in Lagos State, Nigeria. Data were collected through field observation and administration of structured questionnaire. A total of 200 questionnaires were administered through purposive sampling method at 10 respondents/processing centre. Analytical technique used was descriptive statistics. Results revealed that using age and educational level of the processors and availability of household amenities as proxies for socio-economic status, it showed that most of the households were relatively poor. 55.5% were old women and 44.5% were young women. 51.5% had primary school education, 38% had post-primary school education while 10.5% had no schooling. The study found that 98.0% of the processors practiced manual operations while 2.0% practiced mechanical operation. Fish processors in fishing communities play a central role in fisheries and in maintaining the social family structure. Despite the fact that fish and fish products provide significant proportion of the supply of animal protein needs, the fish processors experience seasonal food crisis, particularly the poor women. It is obvious that with seasonal variation in production, fish processors household spend more income on food and increases level of poverty incidence. Seasonal variations in fish supply thereby, leads to serious economic, nutritional and poverty consequences. The study concluded that considering the importance of fish processing to food security and poverty alleviation, especially to coastal communities, a multi-dimensional approach is required to achieve considerable improvement in the living standards of the poor fish processors.

Systematic review and meta-analysis of lactose digestion, its impact on intolerance and nutritional effects of dairy food restriction in inflammatory bowel diseases.

BackgroundRelationships between inflammatory bowel disease and lactose containing foods remain controversial and poorly defined regarding symptoms, nutritional outcomes, and epidemiologic associations for lactose maldigestion.MethodsA literature review was performed using Pub Med, Cochrane library and individual references, to extract data on lactose maldigestion prevalence in inflammatory bowel diseases. A meta-analysis was done using selected articles, to determine odds ratios of maldigestion. Information was collected about symptoms, impact on pattern of dairy food consumption, as well as the effects of dairy foods on the course of inflammatory bowel diseases.ResultsA total of 1022 articles were evaluated, 35 articles were retained and 5 studies were added from review articles. Of these 17 were included in meta-analysis which showed overall increased lactose maldigestion in both diseases. However increased risk on sub analysis was only found in Crohn’s in patients with small bowel involvement. Nine additional studies were reviewed for symptoms, with variable outcomes due to confounding between lactose intolerance and lactose maldigestion. Fourteen studies were evaluated for dairy food effects. There was a suggestion that dairy foods may protect against inflammatory bowel disease. Nutritional consequences of dairy restrictions might impact adversely on bone and colonic complications.ConclusionsLactose maldigestion in inflammatory bowel disease is dependent on ethnic makeup of the population and usually not disease. No bias of increased disease prevalence was noted between lactase genotypes. Intolerance symptoms depend on several parameters besides lactose maldigestion. Dairy foods may decrease risks of inflammatory bowel disease. Dairy restrictions may adversely affect disease outcome.

Effect of proximal versus distal 50% enterectomy on nutritional parameters in rats preconditioned with a high-fat diet or regular chow.

Obesity may protect against the nutritional consequences of short bowel syndrome. We hypothesized that rats preconditioned with an obesogenic diet would have better outcomes after surgical induction of short bowel syndrome compared to rats on regular chow. Rats were fed a high-fat diet or regular rat chow for six months, and then underwent 50% proximal, 50% distal, or sham enterectomy. Food intake, weight, and body composition were monitored before and for 4 weeks after surgery. The high-fat diet consistently produced obesity (>25% body fat). All procedures induced weight loss, but there was no discernable difference between resection vs. sham resection. Rats on the high-fat diet had a greater post-resection loss of body fat compared to rats on chow (36 vs. 26 g, respectively). There was a nonsignificant trend of less lean mass loss in the former compared to the latter rats (16 vs. 33 g, respectively). Enterectomy moderated serum ghrelin, GIP, PPY, insulin, and leptin. Intestinal adaptation was not different between obese vs. non-obese rats. Rats preconditioned with the high-fat diet may have had better retention of lean body mass after a surgical procedure compared to rats on chow. The effect of 50% enterectomy was less than expected.

Quantification of peptides released during in vitro digestion of cooked meat

We aimed to identify and quantify the peptides generated during in vitro digestion of cooked meat by liquid chromatography coupled with high resolution mass spectrometer. A total of 940 non-redundant peptides in the gastric compartment and 989 non-redundant peptides in the intestinal compartment were quantified and identified. Among the 71 different proteins identified, 43 meat proteins were found in the two digestive compartments, 20 proteins were specific to the gastric compartment and 8 proteins to the intestinal compartment. In terms of estimation, the proteins involved in muscle contraction and structure were preferentially enzymatically hydrolyzed in the small intestine. The effect of cooking provided different but less clear patterns of digestion. To the best of our knowledge, this constitutes the highest number of peptides identified in beef meat digests and provides a comprehensive database for meat protein digestion associated with cooking conditions. Such quantitative and qualitative differences may have important nutritional consequences.

Knowledge of sugar content of sports drinks is not associated with sports drink consumption.

To examine U.S. adult knowledge of the sugar content of sports drinks and whether this knowledge and other characteristics are associated with their sports drink consumption. Nonexperimental. Nationally representative 2011 Summer ConsumerStyles survey data. 3929 U.S. adults. The outcome variable was sports drink consumption in the past 7 days. The main exposure variable was knowledge about sports drinks containing sugar. The covariates were sociodemographic characteristics, physical activity, and weight status. Multivariable logistic regression analysis was used to estimate adjusted odds ratios (ORs) for adults consuming sports drinks ≥1 times/wk after controlling for other characteristics. Approximately 22% of adults reported consuming sports drinks ≥1 times/wk. Most adults (71%) agreed that sports drinks contain sugar; however, this agreement was not significantly associated with adults' sports drink consumption. The odds of drinking sports drinks ≥1 times/wk were significantly higher among younger adults aged 18 to 64 years (OR range: 5.46-2.71), males (OR = 2.09), high-school graduates (OR = 1.52), and highly active adults (OR = 2.09). There were disparities in sports drink consumption by sociodemographic characteristics and physical activity level; however, knowledge of sports drinks' sugar content was not associated with consumption. Understanding why some population groups are higher consumers may assist in the development of education, providing those groups with a better understanding of sports drinks' nutritional value and health consequences of excessive sugar consumption in any form.

Withholding feeding during transfusion: Standardization of practice and nutritional outcomes in premature infants.

To evaluate the nutritional impact of a feed-holding guideline during transfusion for infants <32 weeks gestation. A pre-/post-interventional study was conducted after introduction of a guideline to hold feeds during transfusion. Demographic variables in addition to nutritional outcomes were collected on all infants admitted within 48 hours of birth with gestational age <32 weeks. Data was collected during a 6 month period pre-intervention and the 6 month period post-intervention. There were 145 eligible infants. Mean birth weight and gestational age were similar in both periods. In total, 98 infants received transfusions, and 82 of those had an active feeding order prior to at least one transfusion. Total transfusions per infant and transfusions ordered while an infant had active feeding orders were similar in both periods. Time to full feedings was decreased post-intervention (p < 0.001). Weight at 34 weeks, incidence of second IV placement, additional IV fluid use, and hypoglycemia were similar between groups.Of 593 total transfusions, 207 were ordered while an infant had an active order for enteral nutrition. Pre-intervention, 64% of transfusions had feeds held during transfusion. Post-intervention, 87% of transfusions had feeds held during transfusion. Feeds were held more often (p < 0.001) and for a shorter duration (p = 0.005) in the post-intervention group. Implementing a guideline standardizing feeding practices during transfusions in premature infants increases standardization of care and results in decreased variability in practice. Adverse nutritional consequences were not found after the introduction of the routine practice of holding feedings during transfusion in preterm infants.

Effect of a Sodium-Restricted Diet on Intake of Other Nutrients in Heart Failure: Implications for Research and Clinical Practice

BackgroundSodium restriction is the primary dietary therapy for heart failure (HF) patients. Currently, it is unknown if changing diets to reduce dietary sodium in HF causes secondary changes to the intake of other nutrients in this patient population already at nutritional risk. Methods and ResultsHF patients (n = 16; 52 ± 12 years old; 78% male) followed a sodium-restricted diet for 1 week. Nutritional changes were documented at baseline and after a <2,000 mg/d sodium-restricted diet, as measured by food records before baseline and each day during the study. After a 49% reduction in dietary sodium (3,626 ± 956 to 1,785 ± 696 mg/d), we observed a significant reduction in calorie (2,467 ± 748 to 1,931 ± 388 kcal/d; P < .016), carbohydrate (293 ± 108 to 232 ± 56 g/d; P = .013), calcium (995 ± 496 to 609 ± 208 mg/d; P < .004), thiamine (2.0 ± 0.8 to 1.5 ± 0.8 mg/d; P = .020), and folate (412 ± 192 to 331 ± 172 μg/d; P = .019) intakes. There was a decrease in saturated fat (32 ± 18 to 21 ± 6 g/d; P = .032) and a trend to lower total fat (89 ± 34 to 68 ± 19 g/d; P = .066) and higher potassium (1,262 ± 328 to 1,405 ± 268 mg/1,000 kcal; P = .055) intakes. ConclusionsWe found multiple unintentional nutritional consequences with dietary sodium reduction in HF patients. These findings highlight the need to consider the whole diet when counseling HF patients to lower sodium intake.

Food consumption changes in South Africa since 1994

Food consumption patterns in South Africa have changed dramatically over the past decades and likely will continue to change over the coming decades. Various food-related studies conducted over the last few decades indicate that food consumption shifts in South Africa have been towards a more Westernorientated diet, with nutritional consequences contributing to increased obesity and other non-communicable diseases. Several sources of data may be used to examine patterns in food consumption over time. Each of these methods has its own merits depending on the desired outcome, but are difficult to compare as each measures different levels of dietary information. As a result of the lack of regular national or comparable food consumption data in South Africa, the objective of this study was to establish, through the use of databases (FAOSTAT food balance sheets and Euromonitor International© Passport), the broad food and beverage consumption shifts in South Africa since 1994. Our findings indicate that food consumption shifts have been towards an overall increase in daily kilojoules consumed, a diet of sugar-sweetened beverages, an increase in the proportion of processed and packaged food including edible vegetable oils, increased intake of animal source foods, and added caloric sweeteners, and a shift away from vegetables. The largest shifts in food consumption were observed for soft drinks, sauces, dressings and condiments, sweet and savoury snacks, meat, and fats and oils. Convenience, health and nutrition, and indulgence were the main drivers of the increase in consumption of packaged foods and beverages. These shifts in food consumption are concerning as relates to their fat, sugar and salt composition and potential effect on public health.