Restricted Foods Research Articles

Penyuluhan Pemilihan Makanan yang Tepat untuk Menjaga Kadar Glukosa Darah dan Tekanan Darah pada PROLANIS

The PROLANIS is a program conducted by Ngemplak 1 Primary Health Care that gives general clinical examination and activity for patients with diabetes and hypertension. The participants of the PROLANIS program are elderly people with age 50 years old. The nutrition knowledge of PROLANIS members was low, which led them to often ask about good food to maintain blood glucose and blood pressure remained normal. However, the activities to increase knowledge about diet are rarely carried out due to limited human resources at Ngemplak 1 Primary Health Care. Therefore, the counselling method using pocket books about food choices to maintain normal blood glucose levels and blood pressure is carried out to increase knowledge and is expected to improve the quality of life of PROLANIS members. At the end of the session, participants were given a questionnaire to select recommended and restricted foods to manage blood glucose and blood pressure. The result showed that more than 50% of the participants answered the question correctly. This indicated that more than 50% of the participants had understood the counselling materials.

Effects of Inclusion of Food Purchase Restrictions and Incentives in a Food Benefit Program on Diet Quality and Food Purchasing: Results From a Randomized Trial

BackgroundThere is interest in reshaping the Supplemental Nutrition Assistance Program (SNAP) to better support family nutrition. ObjectiveThe Grocery Assistance Program Study (GAPS) for Families evaluated the effects of prohibiting using program funds for the purchase of certain sugary foods on the nutritional quality of foods purchased and consumed by program participants. DesignA randomized experimental trial was carried out with participants randomized to one of three food benefit conditions. Baseline and follow-up measures collected included interviewer-administered 24-hour dietary recalls, food purchase receipts, food security, height, and weight. Participant/settingAdult–child dyads in households eligible for SNAP but currently not enrolled were recruited from the Minneapolis/St Paul MN metropolitan area from May of 2018 through May of 2019. A total of 293 adult–child dyads received the intervention as allocated. Of these dyads, 233 adults completed follow-up measures and met criteria for inclusion in the analytic sample, resulting in an attrition rate of 20.5%. A total of 224 children completed follow-up measures and met criteria for inclusion in the analytic sample, resulting in an attrition rate of 23.5%. InterventionParticipants were randomized to 1 of 3 conditions: restriction (not allowed to buy sugar-sweetened beverages [SSB], sweet baked goods, or candy with program funds); restriction paired with incentive (30% incentive for fruits and vegetables [FV] purchased with funds); and control (funds provided with no restrictions or incentives). Funds were provided on a 4-week cycle for 20 weeks via a study-provided debit card. Main outcome measuresThe primary outcome was the Healthy Eating Index (HEI)-2015 total score. Additional outcomes included selected HEI-2015 component scores; energy intake; food security; body weight; and purchasing of SSB, sweet baked goods, candies, fruits, and vegetables. Statistical analysisLinear regression analyses were conducted with change in the outcome regressed on treatment condition for the primary outcome analyses. ResultsNo differences were observed between conditions in change in the nutrition and food security measures examined. Purchases of SSB and sweet baked goods and candies significantly differed by experimental condition. Purchase of restricted foods was lower at follow-up in the restriction and restriction paired with incentive conditions compared with the control condition. For example, spending on SSB at follow-up was significantly lower in the restriction ($2.66/week) and restriction paired with incentive ($2.06/week) conditions in comparison with control condition ($4.44/week) (P < 0.0003 and P < 0.0001, respectively). ConclusionsThis study failed to find evidence in support of prohibiting the purchase of sugary foods with food program funds as a strategy to improve program participant nutrition, even when paired with an FV incentive. Research carried out in the context of the SNAP program is needed for a more robust evidence base.

Protecting children from unhealthy food marketing: a comparative policy analysis in Australia, Fiji and Thailand.

Restrictions on marketing of unhealthy foods and beverages to children is a globally recommended policy measure to improve diets and health. The aim of the analysis was to identify opportunities to enable policy learning and shift beliefs of relevant actors, to engender policy progress on restrictions on marketing of unhealthy foods to children. We drew on the Advocacy Coalition Framework to thematically analyse data from qualitative policy interviews conducted Australia (n = 24), Fiji (n = 10) and Thailand (n = 20). In all three countries two clear and opposing advocacy coalitions were evident within the policy subsystem related to regulation of unhealthy food marketing, which we termed the 'strengthen regulation' and 'minimal/self regulation' coalitions. Contributors to policy stasis on this issue were identified as tensions between public health and economic objectives of government, and limited formal and informal spaces for productive dialogue. The analysis also identified opportunities for policy learning that could enable policy progress on restrictions on marketing of unhealthy foods to children as: taking an incremental approach to policy change, defining permitted (rather than restricted) foods, investing in new public health expertise related to emerging marketing approaches and scaling up of monitoring of impacts. The insights from this study are likely to be relevant to many countries seeking to strengthen regulation of marketing to children, in response to recent global recommendations.

Parent knowledge regarding food selection for children with PKU: Results of a survey in the United States

ObjectivesDietary treatment is the main therapy for most patients with phenylketonuria (PKU). Parental knowledge regarding food selection is crucial to ensure adequate metabolic control and brain development during childhood and to promote lifelong adherence and healthy dietary behavior in the offspring. The aims of this study were to assess whether parental or caregiver knowledge regarding nutritional selection for children with PKU is in accordance with medical recommendations and to evaluate factors that influence their level of knowledge. MethodsThis was a cross-sectional observational study. An online or paper survey (N = 178) was distributed throughout the United States. The survey included a validated food selection questionnaire to assess whether the respondent adequately identified foods that require certain restrictions versus foods that can be consumed freely by an individual with PKU. ResultsGeneral knowledge of food selection among the caregivers was very high or high in nearly 60% (60–98th score percentile). Participants with the lowest scores in general knowledge of the PKU diet (quartile 1) were more likely to label allowed foods incorrectly. Respondents with the highest scores (quartile 4) were more likely to label limited foods correctly but incorrectly label allowed items. ConclusionKnowledge of restricted foods is important to avoid poor metabolic control, but knowledge of allowed foods can be just as important to allow for a diet that is diverse, palatable, and nutritionally balanced.

Dietary Intake and Nutritional Knowledge: Study in Haemodialysis Patients with Hypertension and Diabetes Mellitus in RUSD Dr. Saiful Anwar Malang

Hypertension and Diabetes Mellitus are the most common causes of Metabolic Syndrome, one of which leads to Chronic Kidney Disease (CKD). Risk factors associated with this condition are diet and nutritional knowledge. This study aims to determine differences in nutritional intake and nutritional knowledge in patients with kidney disease on hemodialysis who have comorbid hypertension and/or diabetes mellitus and/or both. The number of respondents in this cross-sectional study was 27 outpatients undergoing hemodialysis at RSUD Dr. Saiful Anwar Malang, taken by consecutive sampling which met the inclusion criteria. The variables studied were dietarily obtained from the SQ-FFQ and nutritional knowledge was obtained from interviews using a questionnaire form containing questions related to diet, food consumed, restricted foods, and foods to avoid. The results showed that 17 hemodialysis patients suffered from hypertension and 10 patients with hypertension and diabetes mellitus. There was no difference in dietary intake between the hypertension group and hypertension and the diabetes mellitus group (p&gt;0.05), the results of the analysis of nutritional knowledge also showed no difference between the two groups (p&gt;0.05). This study concluded that hemodialysis patients who experienced hypertension and hypertension with Diabetes Mellitus did not show differences in dietary intake and nutritional knowledge.

Restricting diet for perceived health benefit: A mixed-methods exploration of peripartum food taboos in rural Cambodia.

Food taboos encompass food restrictions practiced by a group that go beyond individual preferences. During pregnancy and lactation, food taboos may contribute to inadequate nutrition and poor maternal and infant health. Restriction of specific fish, meat, fruits and vegetables is common among peripartum women in many Southeast Asian countries, but data from Cambodia are lacking. In this mixed-methods study, 335 Cambodian mothers were asked open-ended questions regarding dietary behaviours during pregnancy and up to 24 weeks postpartum. Descriptive statistics and content analysis were used to characterize food taboos and multiple logistic regression analyses were conducted to identify predictors of this practice. Participants were 18-44 years of age, all of Khmer ethnicity and 31% were primiparous. Sixty-six per cent of women followed food taboos during the first 2 weeks postpartum, whereas ~20% of women restricted foods during other peripartum periods. Pregnancy taboos were often beneficial, including avoidance of sugar-sweetened beverages, coffee and alcohol. Conversely, postpartum avoidances typically included nutrient-dense foods such as fish, raw vegetables and chicken. Food taboos were generally followed to support maternal and child health. No significant predictors of food taboos during pregnancy were identified. Postpartum, each additional live birth a woman had reduced her odds of following food taboos by 24% (odds ratio [95% confidence interval]: 0.76 [0.61-0.95]). Specific food taboo practices and rationales varied greatly between women, suggesting that food taboos are shaped less by a strict belief system within the Khmer culture and more by individual or household understandings of food and health during pregnancy and postpartum.

A Cross-sectional Survey to Review Food Safety Practices Within Pediatric Oncology and Stem Cell Transplant Centers in the United Kingdom.

Neutropenia is a common complication of chemotherapy, which poses a high risk of infection and mortality. Neutropenic diet has historically been recommended for those undergoing chemotherapy. The rationale is to reduce the risk of foodborne infection by avoiding foods considered to be of high microbial risk. However, evidence for this diet is limited, and there is a lack of national consensus guidelines. Ascertain food safety advice across specialist centers providing high-dose chemotherapy for malignancy or stem cell transplants in the United Kingdom. Dietitians at 22 centers were contacted to complete a questionnaire regarding food safety guidance implemented at their center for pediatric patients undergoing high-dose chemotherapy or stem cell transplants. Questions related to restricted foods, specific guidelines implemented, ward food provision, and timings of food provision. Sixteen centers responded (73%). Many aspects of neutropenic diet were consistent across centers; avoidance of unpasteurized dairy products (94%), raw/undercooked meat (94%), and unpasteurized pâté (88%). There was a lack of consistency regarding water sources used on wards and unpeeled fruits and vegetables. Food safety guidance for neutropenic patients differs across centers, with some practices seeming outdated and nonevidence based. A national review of food safety guidance should be considered to provide a standardized approach.

Effect of nursing guidelines on adherence to healthy lifestyle practices among patients with a small lower ureteric stone

Background: Urinary stone affects about 12% of the world's population and has become a worldwide health problem. Lifestyle practices can contribute to the risk of urinary stone formation; addressing these practices adequately can provide a simple and more cost-effective measure for the prevention of urinary stones and the reduction of its recurrence among urinary stone patients. The current study aimed to evaluate the effect of nursing guidelines on adherence to healthy lifestyle practices among patients with a small lower ureteric stone.Research design: Quasi-experimental design was used to achieve the aim of this study.Sample: A purposive sample of 60 patients was divided into two groups (30 patients in the study group and 30 patients in the control group).Tool (I): includes part one: demographic characteristics of the patients, part two: included present medical history and previous medical history.Tool (II): Adherence of healthy lifestyle practices scale: it was divided into three subscales regarding consumption of restricted foods, consumption of fluids, and healthy usual self-activities.Results: The mean age for the study and control groups are 38.63 and 41.33 years, respectively. More than one-third (36.7%) and 33.3% respectively of the study and control groups have previous histories of urinary tract stones. There are statistically significant differences in mean scores of adherence levels to healthy lifestyle practices between both groups post the nursing guidelines. Only the majority of the study group (93.3%) achieved a satisfactory level following the nursing guidelines.Conclusion: Nursing guidelines have a positive effect on adherence to healthy lifestyle practices to prevent its recurrence.Recommendations: Creation of an educational unit for urinary tract stone patients in the nephrology and urology hospital. Conducting similar studies on a larger probability sample is recommended to achieve generalization of the findings.

Food Safety and Food Security Challenges among ADHD Children in Covid 19 Pandemic

Attention Deficit and Hyperactivity (ADHD) is a typical neurodevelopmental disorder in children with low levels of copper, iron, zinc, magnesium, and omega-3 fatty acids have been detected in children with ADHD. In contrast, sugar, artificial food colourings, and preservatives have been associated with an increased risk of ADHD. During the COVID-19 pandemic, managing food and nutrition for children with ADHD presented several difficulties. This study was conducted to evaluate the eating patterns of ADHD children, restricted foods (food safety), and the significance/need for parents and caregivers of ADHD children to be aware of food safety and security. The children were between 4 and 12 years old; 64% of the respondents were boys, while 36% were girls. They eat more Indian cuisine and have at least one Indian meal daily, whereas they occasionally enjoy western foods. Children who consume western cuisine are more prone to ADHD than those who consume Indian cuisine. Most parents are aware of the foods children with ADHD should avoid. Regarding ADHD, there is a considerable correlation between children's dietary patterns and food safety. During the pandemic, many parents of children with attention deficit hyperactivity disorder were primarily concerned with ensuring their children received adequate nutrition and coping with an unanticipated financial crisis.

Qualitative Exploration of Dimensions of Restrictive Feeding With Australian Mothers of 6-Year-Olds

ObjectiveExplore the nature and dimensions of restrictive feeding with mothers of 6-year-olds. DesignSemistructured interviews with mothers. Conversations were audio-recorded and transcribed verbatim. SettingBrisbane and Adelaide, Australia. ParticipantsTwenty-nine mothers of 6-year-olds. Phenomenon of InterestMothers’ restrictive feeding practices. AnalysisQualitative thematic analysis. ResultsThis study revealed 6 key themes relating to the restrictive feeding phenomenon: restriction of specific foods and drinks; restrictive feeding practices; mothers’ motivation; mothers’ preferences for restricted foods; patterns over time; and relationships with other controlling feeding practices. Parents’ restrictive feeding practices are likely to be inherently inconsistent, with mothers reportedly varying their practices across different restricted foods, contexts, day to day, and as children age. Mothers intended to either totally restrict or restrict a food/drink in moderation, and these intentions presented qualitatively distinct characteristics across themes. Mothers commonly referred to foods/drinks restricted in moderation as treats, and their liking for these restricted foods/drinks was related to higher child access. Conclusions and ImplicationsThis study provides insights into the nature and dimensions of restrictive feeding. Further research is proposed to clarify these findings and examine the effects of child access, types of restrictive feeding practices, and parent communication on child preferences for restricted foods and drinks across a range of cultural groups.

Dynamic Diet Planner: A Personal Diet Recommender System Based on Daily Activity and Physical Condition

Background and ObjectivesAt the beginning of human civilization, human being needs to undergo immense physical labor to survive. During those days high-calorie diet was essential. However, the evolution of technology has changed the scenario and much lesser amount of physical labor is required to survive in modern hi-tech days, requiring less amount of calorie. The excess calorie gets deposited in the body in the form of white fat. As a consequence, obesity appears as an epidemic all over the world. Long term obesity causes many diseases like heart attack, stroke, diabetes, and many other ailments. It is tough for people, who honestly want to check their obesity by controlling food habits, to continue a static diet chart with fixed restricted foods for a long time. Most of the time, people give up such restrictions on food. It will be very useful if a system exists, that will generate a dynamic diet chart based on calorie spend by the body. MethodsThis research describes a system that will generate a dynamic diet chart based on calorie spend by the body and other data like user's BMI, food preferences, etc. In this system, user can tailor his/her diet chart by changing daily physical activities (activities that burn calories). The main contributions of the proposed system are as follows:•A dedicated hardware system to quantify physical labor during walking and running throughout the day from feet pressure changes along with walk cycle detection.•The proposed hardware system can distinguish between walk and run.•A dynamic diet chart preparation system, where the user has the provision to plan his/her diet chart with food affinity. The entire work is divided into two modules; the first one focuses on the hardware design to detect and quantify physical activities during “walking” and “running”. These data are used in the second part. The second part contains calorie calculation along with the preparation of a dynamic diet chart with food affinity. In the hardware design, an Application Specific Integrated Circuit (ASIC) is proposed to measure the physical activity during “walking” and “running”. ResultAt the time of hardware logic synthesis, VHDL and FPGA are used. Experimental results show that the proposed hardware provides more accurate results than a pedometer. There is no standard metric to measure the performance of the dynamic diet chart generation system. Competency of the dietitian at the time of setting the parameters, honesty of the users at the time of the interactive session, etc. are the main factors that influence heavily the performance of the dynamic diet chart preparation system. The advantage of dynamic diet chart is that users can modify the diet menu as per their wish, and the system generates a diet chart in such a way that calorie intake (through food items) is maintained properly. In addition to this, the user can plan his future meals. DiscussionThis work is an interdisciplinary work. It is a blending of electronics (FSM), design, and computation for decision making; the computation portion includes software engineering, soft computing, etc. Future plan of this work is to integrate this system with “Cloud” to provide different data analysis related services, like region-wise food habit pattern prediction, health-related statistics, etc.

Examining child intake frequency, mothers' own liking and child early exposure as potential predictors of child liking for restricted foods and drinks at 5 years old.

To examine longitudinal patterns of child introduction to foods and drinks targeted for restriction by parents and associations between child intake frequency, mother's own liking, child early exposure and child liking for restricted foods and drinks at 5 years old. The study involved secondary analyses of longitudinal data from mothers and children participating in the NOURISH randomised controlled trial. Patterns of descriptive data were examined, and a binary logistic regression model tested for prediction of child liking of a selection of restricted foods and drinks. Brisbane and Adelaide, Australia. Two hundred and eleven mothers and their first born 5-year-old children. The proportion of children who had tried the selected restricted foods and drinks progressively increased from 14 months to 5 years old. Mothers' own high liking for both sweet and savoury restricted foods and drinks predicted child high liking for the same items at 5 years old. Child high intake frequency at 5 years old also predicted child high liking for sweet foods and drinks, but child early exposure did not predict child liking for the restricted items examined. These results challenge the belief that limiting children's intake of foods high in sugar, fat and/or salt will increase their liking for them. Findings instead suggest that restricting children's access to such foods may be beneficial. While further research is required, mothers should be made aware that their own food preferences may inadvertently influence their child's liking for the very foods they are trying to restrict.

Perceptions on the General Guidelines for the Sale of Food and Beverages at an Elementary School in Mexico City

Abstract Objectives To document the perceptions of an elementary school director in Mexico City concerning the implementation of guidelines for vendors of food and beverages in schools (the Guidelines). Methods We interviewed the director of an elementary school in order to document his perceptions of the Guidelines, his experience –including the day-to-day difficulties encountered– while implementing them, the actors involved in this process and the food and beverages sold at his school. Data analysis was performed through Atlas-ti ® software. Results The level of information reported by the director on the origins of the Guidelines was adequate. Among the causes he referenced for their introduction was the growing prevalence of obesity and diabetes, which he indicated warranted the regulation of food and beverage sales in schools. With regard to the foods and beverages permitted for sale, the information reported was only partial; he recognized that restricted foods were in fact being sold. Information on the Guidelines had been transmitted to him orally by the school district supervisor, and he was provided no list of permitted and prohibited foods and beverages. There were no documents or teaching materials available in the school which could be used for disseminating this information and for training the members of the school committee in charge of supervising the implementation of the Guidelines. To ensure compliance with the Guidelines, the director advised that a specific committee composed of parents and the school district supervisor was monitoring the quality, hygiene and nutritional value of the food. The director believed that prohibiting sugary drinks in schools had produced a substantial and positive change: students had reduced their consumption of soda with favorable health results. In addition, he affirmed that, owing to the implementation of the Guidelines, the students had access to nutritious and quality food. Conclusions Although the school director is a key actor for ensuring Guideline compliance, he lacks the necessary information for implementing the Guidelines correctly given a lack of teaching material and adequate training. Funding Sources National Institute of Public Health.

Knowledge, attitude and practices of patients receiving maintenance haemodialysis in Bloemfontein, South Africa

Introduction: In sub-Saharan Africa, a paucity of data exists in respect of the knowledge, attitudes and practices (KAP) of patients on maintenance haemodialysis (MHD) regarding the dietary adaptations they should make. Methods: In a descriptive, cross-sectional study, conducted in 2017, questionnaires were administered during structured interviews with 75 participants in five MHD-units in Bloemfontein to assess socio-demographics and KAP regarding the ‘renal’ diet. Results: The median age was 50.5 years; 70.7% of participants were male. Overall, 49.4% scored low (< 50%) on knowledge regarding restricted foods, food content of restricted minerals, and phosphate binders; 60.0% reported negative attitudes towards the diet, and 61.4% reported poor adherence practices. Participants with tertiary education (28.0%) had significantly higher knowledge scores than participants with only primary school education (6.7%) (95% CI 3.9%; 73.5%), or those who had only partially completed secondary school (17.3%) (95% CI 6.3%; 64.0%). Only 21.0% reported having received written, and 30.7% verbal, nutrition education in their home language, while 24.0% reported never receiving nutrition education in either their home or second language. Having received nutrition education in a home language and/or second language was associated with significantly higher knowledge scores (95% CI 3.7%; 49.5%). Most (77.3%) reported zero to one consultation with a dietitian per MHD year (NKF-K/DOQI recommends at least three/MHD year). Conclusion: This population on MHD presented with poor KAP regarding the ‘renal’ diet, and inadequate involvement of dietitians in their treatment. Receiving nutritional education in a first or second language significantly increased knowledge of, and insight into, the required dietary adaptations.

Food restriction, nutrition status, and growth in toddlers with atopic dermatitis.

Multiple factors affect growth in children with atopic dermatitis (AD). We investigated food restriction practice, nutrition, and growth in children with AD. Food restriction is defined as restriction ≥3 types of food due to AD or food allergy. A cross-sectional study was performed in 150 children aged 12-36months. recurrent infections, moderate to severe asthma, recent systemic steroid, other diseases affecting growth/nutrition. Growth parameters, SCORing Atopic Dermatitis (SCORAD), hemoglobin, hematocrit, sodium, potassium, albumin, protein, calcium, phosphate, B12, iron, and folate values were determined. Parents completed a 3-day food diary. The prevalence of food restriction was 60.7%. Commonly restricted foods were shellfish 62.7%, nuts 53.3%, egg 50%, dairy 29.3%, and cow's milk 28.7%. Food-restricted children have significantly lower calorie, protein, fat, riboflavin, vitamin B12, calcium, phosphorus and iron intakes and lower serum iron, protein and albumin values. Z scores of weight-for-age (-1.38±1.02 vs -0.59±0.96, P=.00), height-for-age (-1.34±1.36 vs -0.51±1.22, P=.00), head circumference-for-age (-1.37±0.90 vs -0.90±0.81, P=.00), mid-upper arm circumference (MUAC)-for-age (-0.71±0.90 vs -0.22±0.88, P=.00), and BMI-for-age (-0.79±1.15 vs -0.42±0.99, P=.04) were significantly lower in food-restricted compared to non-food-restricted children. More food-restricted children were stunted, underweight with lower head circumference and MUAC. Severe disease was an independent risk factor for food restriction with OR 5.352; 95% CI, 2.26-12.68. Food restriction is common in children with AD. It is associated with lower Z scores for weight, height, head circumference, MUAC, and BMI. Severe disease is an independent risk factor for food restriction.

Effect of dietary status on plasma-fractionated metanephrines in healthy individuals measured by Elisa

ABSTRACT Pheochromocytoma is a rare tumor that typically originates in the adrenal glands, often causing the over-production of catecholamines. The aim of this study was to determine whether dietary status could affect the concentration of plasma-fractionated metanephrines. This study was conducted at the Chemical Pathology Laboratory, Royal Hospital, Oman. Three plasma samples were collected from each participant (16 male and 16 female) over three consecutive days (day one: dietary restriction,day two: excess intake of restricted foods, day three: random sample following the typical diet for each participant). Samples were collected and centrifuged to obtain the plasma, which was then stored at −20°C prior to analysis. Metanephrine and normetanephrine concentrations were measured by comparative ELISA. Plasma metanephrine and normetanephrine measured under the three different dietary conditions for each individual were not significantly different and within normal range. Pearson correlation coefficient analysis of plasma concentration of metanephrines within individual patients under the three dietary conditions revealed positive correlation. We found no significant effect of dietary status on plasma metanephrine or normetanephrine concentration. Therefore, samples taken under any dietary condition may be used to determine plasma MN and NMN concentration. However, dietary restrictions in the diagnosis of Pheochromocytoma need further investigations.

Why are restricted food items still sold after the implementation of the school store policy? the case of South Korea

The South Korean government has banned sales of unhealthy foods in school stores since 2009; however, most school stores still sell restricted foods. This study aimed to understand the implementation processes and the reasons for incomplete implementation of the school nutrition policy in South Korea. Semi-structured interviews were conducted with 33 policy actors including school store owners, school staff, public officials, politicians, employees of food companies, and experts. Observations of foods sold in school stores were conducted. Interview transcripts were analyzed using both emergent codes and an a priori code list (participants, base values, perspectives, and effects) based on Lasswell’s social process model using NVivo 10. All interviewees perceived that school stores complied with the policy well; however, restricted foods were found in all interviewed school stores during the observations. Although all policy actors understood the intent of the policy; some of them were not interested in the policy or were unsatisfied with the policy and its outcomes such as profit loss. Perspectives and values towards the policy were different for each policy actor group. Poor monitoring of school store foods, lack of awareness of the policy, profit-seeking, and lack of interest in school stores were identified as reasons for incomplete implementation of the policy. The findings support the needs for consideration of various actors’ perspectives, especially for those who are affected by the policy, when implementing school nutrition policies. A stronger understanding of various actors’ involvement in policy processes can inform strategies to enhance implementation and thereby reach outcomes that align with the original policy intent.

Amino acid disorders.

Amino acids serve as key building blocks and as an energy source for cell repair, survival, regeneration and growth. Each amino acid has an amino group, a carboxylic acid, and a unique carbon structure. Human utilize 21 different amino acids; most of these can be synthesized endogenously, but 9 are "essential" in that they must be ingested in the diet. In addition to their role as building blocks of protein, amino acids are key energy source (ketogenic, glucogenic or both), are building blocks of Kreb's (aka TCA) cycle intermediates and other metabolites, and recycled as needed. A metabolic defect in the metabolism of tyrosine (homogentisic acid oxidase deficiency) historically defined Archibald Garrod as key architect in linking biochemistry, genetics and medicine and creation of the term 'Inborn Error of Metabolism' (IEM). The key concept of a single gene defect leading to a single enzyme dysfunction, leading to "intoxication" with a precursor in the metabolic pathway was vital to linking genetics and metabolic disorders and developing screening and treatment approaches as described in other chapters in this issue. Amino acid disorders also led to the evolution of the field of metabolic nutrition and offending amino acid restricted formula and foods. This review will discuss the more common disorders caused by inborn errors in amino acid metabolism.

The Supplemental Nutrition Assistance Program: Current and Proposed Restricted Food Expenditures

Between 2000 and 2017, a total of 23 states proposed legislation to further restrict Supplemental Nutrition Assistance Program (SNAP) purchases. In the absence of a pilot program, the potential effect of such restrictions is unclear. The objective of this study is to provide insight on the proposed restrictions' effectiveness by characterizing SNAP households' expenditures on current and proposed restricted foods, and comparing them with their cash expenditures. Restrictions on sugar-sweetened beverages, snack foods, and foods ineligible under the Special Supplemental Program for Women, Infants and Children (WIC) are considered. The National Household Food Acquisition and Purchase Survey (collected 2012-2013) provided weekly food expenditures for 1,234 SNAP households. Descriptive statistics and t-tests (completed in 2017) were used to characterize and compare households' cash and restricted food expenditures. On average, SNAP households' allocated 7%, 6%, 17%, and 66% of their food expenditures to currently restricted foods, sugar-sweetened beverages, snack foods, and WIC-ineligible foods. Given a sugar-sweetened beverage or snack food restriction, the average SNAP household can cover their restricted expenditures with cash. However, the average household's expenditures on current restricted and WIC-ineligible foods exceed their cash expenditures by a mean of $40.84 (SE=$2.44). Note that results characterize the impact of proposed SNAP restrictions on the average SNAP household. Individually, it is likely that some SNAP households would be affected by a sugar-sweetened beverage or snack food restriction. Legislation restricting specific foods will likely be less effective at altering SNAP households' food expenditures than legislation seeking to restrict all WIC-ineligible foods.

Predictive modelling of the exposure to steviol glycosides in Irish patients aged 1-3 years with phenylketonuria and cow’s milk protein allergy

ABSTRACTChildren with Phenylketonuria (PKU) and severe cow’s milk protein allergy (CMPA) consume prescribed, specially formulated, foods for special medical purposes (FSMPs) as well as restricted amounts of normal foods. These patients are exposed to artificial sweeteners from the consumption of a combination of free and prescribed foods. Young patients with PKU and CMPA have a higher risk of exceeding acceptable daily intakes (ADI) for additives than age-matched healthy children. A predictive modelling approach has been adapted successfully to assess the additive exposure of young patients with PKU and CMPA to artificial sweeteners. Steviol glycosides (E960) are at various stages of regulatory approval for the various food categories in the EU but are not as yet permitted for use in products intended for young children. The aim of this study was to predict potential steviol glycoside exposure in young children with PKU and CMPA considering the potential for future provisions for the use of this sweetener. The recent introduction of steviol glycosides means that no exposure data are available for children with CMPA and PKU. Food consumption data were derived from the food consumption survey data of healthy young children in Ireland from the National Preschool and Nutrition Survey (NPNS, 2010–11). Specially formulated amino acid-based FSMPs are used to replace whole or milk protein foods and were included in the exposure model to replace restricted foods. The recommendations to ensure adequate protein intake in these patients were used to determine FSMP intake. Exposure assessment results indicated that the maximum permitted level (MPL) for FSMPs would warrant careful consideration to avoid exposures above the ADI. These data can be used to inform recommendations for the medical nutrition industry.