Supplementation Guidelines Research Articles

Examining the Role of Health Facilities in Supporting Iron Folic Acid Supplementation Adherence Among Women in Malawi (OR25-03-19)

ObjectivesMaternal anemia is a major public health problem in many low and middle income countries. In Malawi, consumption of iron folic acid supplements (IFA) has remained low and unchanged since 2004, even with the support of national policy and programs. To understand program implementation challenges, our study examined the relationship between the IFA-related health service environment (HSE) during antenatal care (ANC) and women’s adherence to IFA supplementation guidelines. MethodsData from the 2015–16 Malawi Demographic and Health Survey (DHS) and the 2013–14 Malawi Service Provision Assessment (SPA), both of which collect GPS data of clusters or health facilities, were used. Each DHS cluster was linked to SPA facilities within a specified buffer distance (5 km for urban and 10 km for rural) using GPS data. IFA-related HSE was defined as availability of IFA, observed prescription of IFA, and observed counseling on IFA in health facilities within the buffer. The HSE variables were aggregated to the cluster-level and classified as low, medium, or high. Multilevel logistic regressions, stratified by urban and rural locale, were used to model associations between consumption of IFA and HSE variables controlling for individual-level factors. ResultsIn Malawi 44% of women in urban and 32% in rural areas reported IFA consumption for at least 90 days during their most recent pregnancy. IFA supplements were available in the majority of health facilities (94%) providing ANC. Among clients, 85% received IFA or were given a prescription, 59% were counseled on how to use IFA, and 3% were counseled on side effects. In rural areas, regression models showed that high levels of IFA availability in facilities (OR = 2.07; 95% CI: 1.13–3.80) and IFA counseling (OR = 1.42; 95% CI: 1.12–1.78) were associated with IFA consumption. No associations with any HSE variables were observed in urban areas. ConclusionsDespite widespread availability and prescription of IFA supplements from health facilities, receipt of counseling was low, particularly for side effects. Findings in rural areas reinforce the importance of health system strengthening to ensure IFA availability and counseling to support IFA consumption during pregnancy. Further research is warranted to investigate factors that affect IFA consumption in urban areas. Funding SourcesUnited States Agency for International Development (USAID) through the DHS Program (7200AA18C00083).

Development of an Infection Prevention Review Process for Clinical Trials with Oncolytic Viruses, Gene Therapy, and Other Biologic Agents

BACKGROUND Clinical trials with oncolytic viruses, gene therapy, and other biologic agents are becoming more common in healthcare facilities but study protocols often do not include infection prevention (IP) practices. Although many of these biologic agents are unable to replicate, there is still concern for unintended exposures during the preparation and administration process that could lead to adverse outcomes in patients or employees. We implemented an IP review process for clinical trials with biological agents to ensure safe IP practices are followed. METHODS A policy was created to outline IP requirements for clinical trials based on the type of biologic agent used and the route of administration. To facilitate a review process, IP was notified of new clinical trials with oncolytic viruses, gene therapy, and other biologic agents at the time of approval by the Institutional Biosafety Committee (IBC). Review included completion of a risk assessment and an in-person meeting to evaluate the IP practices included within existing study protocols. We specifically focused on protocols for safe preparation of the biologic agent in the pharmacy, safe handling during administration, isolation requirements during and after administration, and disinfection practices in all areas where the biologic agent is handled. Additional IP guidelines were created if limited or no guidelines existed. RESULTS The review process was implemented in 2015 and IP has been notified of 32 new studies by the IBC. Supplemental IP guidelines were incorporated into existing protocols based on practices that were agreed upon during the review process. CONCLUSIONS Most clinical trials with oncolytic viruses, gene therapy, and other biologic agents lack sufficient IP guidelines in their study protocols. By developing an IP review process, clinical trials at our institution now have more robust IP guidelines in place to prevent unintentional exposures.

Plejotopowe działanie witaminy D

Numerous scientific reports highlighting multiplanar activity of vitamin D, strengthened position of its supplementation guidelines for general population and groups at risk of deficiency from the first day of life until the late senility. Skin synthesis and intestinal absorption are the basic sources of cholecalciferol. The best vitamin D status indicator is the concentration of long half-life 25(OH)D metabolite in the serum. The diagnostic standard should be simultaneous as- say of 25(OH)D2 and 25(OH)D3, that is total 25(OH)D. Current guidelines do not recommend the routine 25(OH)D concentration screening in the general population, but in groups at risk of deficiency only. Therapy based on calcium and phosphorus metabolism, related to rackets prevention, assumes the target 25(OH)D concentration of 20 ng/ml. The treatment focusing on pleiotropic effect of vitamin D recommends the target concentration of 30–50 ng/ml. Prophylactic doses should depend on age, body weight, seasonal insolation level, sun exposure and individual determinants such as diet and lifestyle. The prophylactic dose for an adult (19–65 years) with normal body weight is 800–2000 IU/day. Notwithstanding, the in- crease of intake of dietary supplements containing cholecalciferol, epidemiological studies estimate the vitamin D deficiency between 50 and 70% in the European population, and 90% in Poland. Treatment of clinically confirmed deficiency (25(OH)D < 20 ng/ml) should be continued until the concentration of 30–50 ng/ /ml. The proper therapeutic strategy choice should be based on one’s individual health outcome concerns, age, body weight and dietary habits.

Assessment of adrenal reserve and secretion of cortisol in patients over 60 years of age undergoing cardiac surgery.

IntroductionCortisol level affects the prognosis of patients after cardiac surgery. Meanwhile, there are no clear guidelines for steroid supplementation after a cardiac operation. The relationship between age and blood cortisol levels has not been finally clarified.AimAssessment of adrenal reserve and secretion of cortisol in patients over 60 years of age undergoing cardiac surgery.Material and methodsThe study included 20 patients of both sexes referred for cardiac surgery. A short ACTH synthetic stimulation test was carried out. Assessment of cortisol secretion was carried out in the morning on the day of surgery and the 1st, 2nd and 4th days after surgery in blood samples.ResultsA result within the normal range for the adrenal reserve was found in 19 of the 20 patients enrolled in the study. The short Synacthen test predicted postoperative secretion of cortisol (p = 0.04, r = 0.047). A relationship between secretion of cortisol and patients’ age was observed (p = 0.03, r = 0.48). The concentration of cortisol on the 1st postoperative day was correlated with the total dose of dopamine (p = 0.006, r = 0.58) and adrenaline (p = 0.04, r = 0.47). The concentration of cortisol on the day of the surgery correlated with the lactate concentration on day 2 (p = 0.04, r = 0.45). The concentration of lactates on day 1 correlated with total dose of dopamine (p = 0.01, r = 0.54).ConclusionsA short Synacthen test allows one to predict secretion of cortisol after cardiac surgery. Greater secretion of cortisol after cardiac surgery may be associated with a more difficult postoperative course. There was no decrease in cortisol secretion with age.

Metabolic surgery and iron homeostasis.

Iron deficiency and anaemia after metabolic surgery, potentially modifiable nutritional complications, are becoming an increasing cause for concern as prevalence increases with time and there is limited evidence supporting the effectiveness of the current guidelines for prophylactic oral iron supplementation and treatment for deficiency. Abnormalities in iron nutrition predisposing to deficiency are common in severely obese patients, and the low-grade systemic inflammation, also common to these patients, reduces the effectiveness of oral iron supplementation. The surgical procedures result in alterations of foregut anatomy and physiology, which limit iron absorptive capacity and daily food intake. These alterations and the limited effects of oral iron supplementation explain the high prevalence of postoperative iron deficiency and anaemia. This review outlines current mechanisms concerning the pathogenesis of disordered iron nutrition in patients with severe obesity, current gaps in knowledge, and opportunities for quality improvement.

25(OH)D Concentration in Neonates, Infants, and Toddlers From Poland-Evaluation of Trends During Years 1981-2011.

Introduction: The numerous evidence showing spectrum of vitamin D effects on human health resulted in both updates of vitamin D supplementation guidelines for general population and concerns on potential risk of hypercalcaemia. The aim of this study was to analyse trends in serum 25-hydroxyvitamin D concentration (25(OH)D) change over the 30 years of operation of a single pediatric diagnostic unit.Materials and methods: Calcium-phosphate metabolism markers and 25(OH)D concentrations were analyzed in a group that consisted of newborns and infants commissioned for diagnostics due to suspected calcium-phosphate metabolic disturbances (n = 3,163; mean age 8.0 ± 3.0 months).Results: 25(OH)D < 10 ng/ml was noted in 4.5% of patients (n = 163), 10–20 ng/ml in 14.7% (n = 465), 20–30 ng/ml in 23.9% (n = 756) and 30–50 ng/ml in 35.9% (n = 1,136). The mean 25(OH)D concentration in analyzed group was 37.5 ± 24.5 ng/ml. In patients with 25(OH)D concentration < 10 ng/ml a normal calcaemia (2.25–2.65 mmol/l) was noted in 83.4% cases (n = 136). Eighty one patients had 25(OH)D concentrations above 100 ng/ml with co-existing calcaemia in range of 2.6–4.38 mmol/l (mean Ca = 2.69 mmol/l). Hypocalcaemia (Ca < 2.25 mmol/l) was observed in 0.54%, (n = 17). 13.8% patients revealed calcium levels >2.65 mmol/l (n = 435). In general, the mean calcium-phosphate markers values were within the reference range for age. The highest mean 25(OH)D concentration of 51.8 ng/ml ± 38.8 was noted in years 1981–1999 (n = 305). The lowest mean 25(OH)D value was observed in years 2010–2011 (29.0 ng/ml ± 13.6; n = 412). The trend of decreasing 25(OH)D concentration during analyzed time period was significant (r = −0.29, p < 0.0001).Conclusions: Eighty percentage of children aged 0–36 months had 25(OH)D concentration >20 ng/ml, however, during 3 decades a mean 25(OH)D concentrations trended significantly to decrease. A direct relationship between low 25(OH)D concentration and hypocalcaemia was not observed nor between high 25(OH)D concentration and hypercalcemia.

Applying international guidelines for calcium supplementation to prevent pre-eclampsia: simulation of recommended dosages suggests risk of excess intake in Ethiopia.

To simulate impact of Ca supplementation on estimated total Ca intakes among women in a population with low dietary Ca intakes, using WHO recommendations: 1·5-2·0 g elemental Ca/d during pregnancy to prevent pre-eclampsia. Single cross-sectional 24 h dietary recall data were adjusted using IMAPP software to simulate proportions of women who would meet or exceed the Estimated Average Requirement (EAR) and Tolerable Upper Intake Level (UL) assuming full or partial adherence to WHO guidelines. Nationally and regionally representative data, Ethiopia's 'lean' season 2011. Women 15-45 years (n 7908, of whom 492 pregnant). National mean usual Ca intake was 501 (sd 244) mg/d. Approximately 89, 91 and 96 % of all women, pregnant women and 15-18 years, respectively, had dietary Ca intakes below the EAR. Simulating 100 % adherence to 1·0, 1·5 and 2·0 g/d estimated nearly all women (>99 %) would meet the EAR, regardless of dosage. Nationally, supplementation with 1·5 and 2·0 g/d would result in intake exceeding the UL in 3·7 and 43·2 % of women, respectively, while at 1·0 g/d those exceeding the UL would be <1 % (0·74 %) except in one region (4·95 %). Most Ethiopian women consume insufficient Ca, increasing risk of pre-eclampsia. Providing Ca supplements of 1·5-2·0 g/d could result in high proportions of women exceeding the UL, while universal consumption of 1·0 g/d would meet requirements with minimal risk of excess. Appropriately tested screening tools could identify and reduce risk to high Ca consumers. Research on minimum effective Ca supplementation to prevent pre-eclampsia is also needed to determine whether lower doses could be recommended.

Dietary supplementation usage by pregnant women in Silesia - population based study.

Despite wide access to gynecological and obstetric advice, informational campaigns, and information online and in magazines aimed at pregnant women, there is a worryingly high percentage of women who still do not use recommended dietary supplementation. The aim of this study was to assess the frequency of micronutrient supplementation by pregnant women and to specify the determinants that impact decisions concerning supplementation. A cross-sectional survey was conducted between June 2016 and May 2017 among a group of pregnant women visiting gynecological and obstetric clinics in the Silesia region, who have completed an authorized questionnaire developed for the purpose of this study. The questionnaire addressed the women's dietary habits, micronutrient supplementation use, as well as their socio-economic status. Completed questionnaires were obtained from 505 pregnant women. Microminerals and vitamins supplementation during pregnancy was declared by 410 (81.2%) women. The most often used supplement was folic acid (62%). More than one-third of pregnant women (38.4%) declared vitamin D intake. Among the recommended supplements, the least commonly used (30.3%) were polyunsaturated fatty acids (PUFA). Factors contributing to supplementation use during pregnancy are past history of miscarriage and socioeconomic factors, such as: place of residence, financial situation and level of education. Inhabitants of larger cities, women with better self-perceived financial situations, higher education levels and those presenting past history of miscarriage took the supplements significantly more often. Lower levels of education, low-income financial status and living in rural localities are among the factors correlating with worse adherence to supplementation guidelines.

The Role of Polyphenols in Human Health and Food Systems: A Mini-Review.

This narrative mini- review summarizes current knowledge of the role of polyphenols in health outcomes—and non-communicable diseases specifically—and discusses the implications of this evidence for public health, and for future directions for public health practice, policy, and research. The publications cited originate mainly from animal models and feeding experiments, as well as human cohort and case-control studies. Hypothesized protective effects of polyphenols in acute and chronic diseases, including obesity, neurodegenerative diseases, type 2 diabetes, and cardiovascular diseases, are evaluated. Potential harmful effects of some polyphenols are also considered, counterbalanced with the limited evidence of harm in the research literature. Recent international governmental regulations are discussed, as the safety and health claims of only a few specific polyphenolic compounds have been officially sanctioned. The implications of food processing on the bioavailability of polyphenols are also assessed, in addition to the health claims and marketing of polyphenols as a functional food. Finally, this mini-review asserts the need for increased regulation and guidelines for polyphenol consumption and supplementation in order to ensure consumers remain safe and informed about polyphenols.

DUCHENNE MUSCULAR DYSTROPHY – CLINICAL: P.18The importance of nutrition in Duchenne muscular dystrophy

Duchenne muscular dystrophy (DMD) is a severe progressive muscular dystrophy caused by mutations in the DMD gene, leading to the absence of a functional dystrophin protein. Besides muscle problems, metabolic, gastrointestinal (GI), and resulting nutritional issues contribute to the pathology. This aspect of the disease is often neglected. Assessment by a dietician should be part of routine check-ups. In early stages, overweight, caused in part by corticosteroid use, is common and, together with the primary deficit in dystrophin, affects muscle and whole body metabolism. In later stages patients are at risk of undernutrition, e.g. due to problems with swallowing and chewing. When the disease progresses, GI issues, including constipation, metabolic acidosis, gastroparesis, and reflux, are often seen. The precise role of nutrition and metabolic problems has not been well-studied. There is a need for natural history data, including dietary data, and good outcome measures regarding body composition, tailored to DMD patients. Furthermore, few well-designed studies, both preclinical and clinical, into the use of dietary supplements and on nutrient requirements have been performed. Good guidelines for maintaining a healthy weight and nutritional intake are currently lacking. Additionally, the risk/benefit ratio of high doses of over-the-counter supplements, their effect on different muscle types and potential interactions with other medicines require more detailed investigation. Families should be encouraged to speak with the clinical team and the pharmacist. The importance of fluid intake and dental hygiene should be stressed as well. Guidelines for diet and supplements need to take into account the stage of the disease and background culture, and be readily accessible in understandable formats, such as short videos and one-page explanations. It may also be helpful to provide examples of recipes and alternatives to make implementation of dietary change in daily life easier.

Associations of serum calcium levels and dietary calcium intake with incident type 2 diabetes over 10\xa0years: the Korean Genome and Epidemiology Study (KoGES)

BackgroundPrevious evidence regarding the associations between serum calcium concentrations, dietary calcium intake, and type 2 diabetes (T2D) is limited. We investigated the longitudinal associations of serum calcium levels and dietary calcium intake with T2D development.MethodsThis study used data from the Ansung–Ansan cohort, a community-based, prospective cohort that was followed up for 10 years. Cox regression models adjusted for potential confounders were used to evaluate the associations of serum calcium levels (mean, 9.41 mg/dL) and dietary calcium intake (median, 389.59 mg/day) with T2D incidence. Association between dietary calcium intake and serum calcium levels was assessed using linear regression models.ResultsAlbumin-adjusted serum calcium levels were not associated with T2D risk (hazard ratio [HR] = 1.07, 95% confidence interval [CI] 0.96, 1.19, p-value = 0.2333). A one-unit increase in log-transformed, energy-adjusted dietary calcium intake was associated with a decreased risk of T2D (HR = 0.88, 95% CI 0.77, 1.00, p-value = 0.0460) and lower albumin-adjusted serum calcium levels (β = − 0.04, 95% CI − 0.07, − 0.02, p-value = 0.0014). The associations did not differ according to sex (all p-values for interaction > 0.10).ConclusionsSerum calcium levels were not associated with T2D risk, while higher dietary calcium intake was associated with a decreased risk of T2D development. These results have public health implications for predicting and preventing T2D development, as well as providing guidelines for diet and calcium supplementation.

Vitamin D Supplementation Guidelines for General Population and Groups at Risk of Vitamin D Deficiency in Poland-Recommendations of the Polish Society of Pediatric Endocrinology and Diabetes and the Expert Panel With Participation of National Specialist Consultants and Representatives of Scientific Societies-2018 Update.

Vitamin D deficiency is an important public health problem worldwide. Vitamin D deficiency confers a significant risk for both skeletal and non-skeletal disorders and a number of lifelong negative health outcomes. The objectives of this evidence-based guidelines document are to provide health care professionals in Poland, an updated recommendation for the prevention, diagnosis and treatment of vitamin D deficiency. A systematic literature search examining the prevention and treatment strategies for vitamin D deficiency was conducted. Updated recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation system describing the strength of the recommendation and the quality of supporting evidence. Twenty-seven contributors representing different areas of expertise and medical specialties, including pediatricians, geriatricians, endocrinologists, epidemiologists, nephrologists, gynecologists and obstetricians evaluated the available published evidence related to vitamin D, formulated the goals of this document and developed a common consolidated position. The consensus group, representing six national specialist consultants and eight Polish and international scientific organizations/societies, participated in the process of grading evidence and drawing up the general and specific recommendations. The updated recommendations define the diagnostic criteria for the evaluation of vitamin D status and describe the prevention and treatment strategies of vitamin D deficiency in the general population and in groups at increased risk of the deficiency. Age- and weight-specific recommendations for prevention, supplementation and treatment of vitamin D deficiency are presented, and detailed practice guidance is discussed regarding the management in primary and specialized health care. Vitamin D deficiency remains still highly prevalent in Poland, in all age groups. Currently, there is a great necessity to implement a regular supplementation with recommended doses and to develop an effective strategy to alleviate vitamin D deficiency in the population. These updated recommendations are addressed to health professionals and the authorities pursuing comprehensive health policies and should also be included in public health programs aimed at preventing a broad spectrum of chronic diseases.

Guidelines for iron supplementation for Prophylaxis of Anemia in a National Programme - A Review

Recent National Family Health Survey-4 data shows that anaemia continues to be a major public health problem in India. In India much of the anaemia is due to iron deficiency, and women and children are at the greatest risk of anaemia. TheMinistry of Health and Family Welfare took a policy decision, in 2013, to develop the National Iron+ Initiative (NIPI) to address the prevailing iron deficiency anaemia. This initiative covered pregnant and lactating women, children and adolescents. However, the guidelines do not match the current World Health Organization (WHO) guidelines for prevention of iron deficiency anaemia in these population groups. The background evidence for the WHO and NIPI is thus reviewed to come to a common consensus on the optimum recommendation of iron supplementation for the population, while taking into consideration the feasibility of the program, without burdening the groups with iron over-dose. However, from the present review, there is a need for increased number of trials in India that could qualify for a high grade of evidence to support the guidelines of NIPI.

Feasibility of integrating calcium and iron-folate supplementation to prevent preeclampsia and anemia in pregnancy in primary healthcare facilities in Kenya.

Calcium (Ca) supplementation to prevent preeclampsia can save maternal and newborn lives, but there are no program models for integration into existing antenatal care platforms. We used a program impact pathway model to guide the design of integrated Ca and iron-folate (IFA) supplementation in Kenya. We provided healthcare providers with job aids (posters and counseling cards), trained them on counseling techniques and supplementation guidelines, and developed behavior change materials for pregnant women (pill-taking calendars). We allocated health facilities to prescribe either 1.0 or 1.5g/day Ca, with standard IFA. We collected implementation data from 16 facilities and 990 women. We also explored effects of supplementation on percentage of the population meeting recommended daily allowance. Supplements and job aids were available during 90% of facility spot-check episodes; calendar availability was lower (78%). Over 98% of clients received Ca and IFA supplements, but only 76% received enough Ca supplements to last between antenatal care visits. Among clients that still had pills by return date, adherence was 77% and 83% for the IFA and Ca regimen, respectively. When 1.5g/day of Ca supplements were prescribed, over 75% of participants met recommended daily allowance. Only 54% met the recommended daily allowance when 1.0g was prescribed. This study illustrates a systematic approach for integrating Ca supplementation into primary healthcare and demonstrates that such integration is feasible when contextual bottlenecks are addressed. Policy makers and program planners should pay attention to supply chain, healthcare worker dispensing behavior, and appropriateness of regimen for their settings.

The Changes of Colonic Bacterial Composition and Bacterial Metabolism Induced by an Early Food Introduction in a Neonatal Porcine Model.

The impact of an early food introduction on the microbiota composition and microbial metabolism in colon was investigated using a new-born piglet model. At day 4 after birth, 10litters of piglets were randomly allocated to a sow-rearing group (SR group) and a milk-replacer supplementing group (MRS group) (n = 5). A commercial milk replacer was given to the suckling piglets in the MRS group from the 4th day to the 28th day. Pyrosequencing of the V3-V4 region of the 16S rRNA genes showed that the milk replacer supplementation significantly decreased the relative abundance of Lactobacillus, Clostridium XI, Blautia, Clostridium sensustricto and Escherichia (p = 0.08) in the colon of the piglets, but significantly increased the relative abundance of Paraprevotella on the 28th day. In addition, the abundance of Rumminococcus, Clostridium XlVa, Succiniclasticum, Clostridium IV tended to increase in the MRS group. The concentrations of acetate, propionate, butyrate, valerate and branch-chain fatty acids (BCFAs) in the colonic digesta increased with the milk replacer supplementary in the MRS group. In addition, the milk replacer supplementary increased the expression level of Toll-like receptor 4 (TLR4), but decreased the expression level of interleukin-6 (IL-6) in the colonic mucosa of the piglets. In conclusion, an early food introduction can influence the gut bacterial composition and metabolism, and may further affect the intestinal health by modifying the gene transcription related to the colonic function. These findings may provide some guidelines for the early nutrition supplementation for infants during the lactation period.

Scaling-up interventions to improve infant and young child feeding in India: What will it take?

We assessed India's readiness to deliver infant and young child feeding (IYCF) interventions by examining elements related to policy, implementation, financing, and evidence. We based our analysis on review of (a) nutrition policy guidance and program platforms, (b) published literature on interventions to improve IYCF in India, and (c) IYCF program models implemented between 2007 and 2012. We find that Indian policies are well aligned with global technical guidance on counselling interventions. However, guidelines for complementary food supplements (CFS) need to be reexamined. Two national programs with the operational infrastructure to deliver IYCF interventions offer great potential for scale, but more operational guidance, capacity, and monitoring are needed to actively support delivery of IYCF counselling at scale by available frontline workers. Many IYCF implementation efforts to date have experimented with approaches to improve breastfeeding and initiation of complementary feeding but not with improving diet diversity or the quality of food supplements. Financing is currently inadequate to deliver CFS at scale, and governance issues affect the quality and reach of CFS. Available evidence from Indian studies supports the use of counselling strategies to improve breastfeeding practices and initiation of complementary feeding, but limited evidence exists on improving full spectrum of IYCF practices and the impact and operational aspects of CFS in India. We conclude that India is well positioned to support the full spectrum of IYCF using existing policies and delivery platforms, but capacity, financing, and evidence gaps on critical areas of programming can limit impact at scale.

Differential Effects of High-Protein Diets Derived from Soy and Casein on Blood–Brain Barrier Integrity in Wild-type Mice

A number of studies report that a diet high in protein influences cognitive performance, but the results are inconsistent. Studies demonstrated that protein from different food sources has differential effects on cognition. It is increasingly recognized that the integrity of cerebrovascular blood–brain barrier (BBB) is pivotal for central nervous system function. However, to date, no studies have reported the effects of high-protein diets on BBB integrity. Therefore, in this study, the effects of diets enriched in casein or soy protein on BBB permeability were investigated. Immunomicroscopy analyses of cerebral parenchymal immunoglobulin G extravasation indicated significant BBB disruption in the cortex of young adult mice maintained on high-casein diet for 12 weeks, while no signs of BBB dysfunction were observed in mice fed with control or high-soy protein diet. Moreover, cortical expression of glial fibrillary acidic protein (GFAP) was significantly greater in mice fed the high-casein diet compared to control mice, indicating heightened astrocyte activation, whereas mice maintained on a soy-enriched diet showed no increase of GFAP abundance. Plasma concentrations of homocysteine were markedly greater in mice maintained on a high-casein diet in comparison to control mice. Collectively, these findings suggest that a diet enriched in casein but not soy protein may induce astrocyte activation through exaggerated BBB permeability by increased plasma homocysteine. The outcomes indicate the differential effects of protein sources on BBB and neuroinflammation, which may provide an important implication for dietary guidelines for protein supplementation.

Level of micronutrient supplements uptake among people living with HIV/AIDS in Kayole, Nairobi County, Kenya

Micronutrients reduce morbidity and slow the rate of disease progression and thus, micronutrient supplementation in HIV is recommended. This study established the level of uptake of micronutrient supplements among people living with HIV in Kayole, Nairobi County. A cross-sectional analytical design was adopted on a comprehensive sample of 153 adults living with HIV, enrolled at Comprehensive Care Centre in Kayole Health Centre. Data is described by use of percentages while relationships are assessed using chi-square. Qualitative data from focus group discussions and key informants was transcribed and analyzed to complement the quantitative findings. Results showed that only 13.7% of the respondents were on micronutrients at the time of the study. The micronutrient supplements commonly supplemented were vitamin and mineral mix (50.3%), zinc (34%), vitamin B6 (24.2%), vitamin A (24.2%), folate (12.4%), and iron (15%). The main reason for supplementation was; those on Antiretroviral Therapy (66.7%), due to the presence of opportunistic infections (40.5%), those who had no appetite (28.1%), underweight cases (21.6%) and those on tuberculosis treatment (17.0%). The main reason for low uptake was due to stock outs at treatment centre (24.8%), the high cost of supplements (13.7%) and side effects after intake (5.9%). Adults living with HIV are aware of the importance of micronutrients and had taken micronutrient supplements at one point during the treatment period. However, uptake at the time of the study was low. This was due to lack of guidelines for supplementation, high cost of supplements, stock-outs in health facilities and side effects. This study recommends proper education and sensitization on supplementation. Standard guidelines and policies for micronutrient supplementation should be developed. A pull system should be adapted in the supply of supplements. Key words: Micronutrients, supplementation, people living with HIV, Kenya, adults.

Rice landraces diversity for developing products of food supplements and functional food in Chachoengsao province

This research aims to: (1) study the diversity of traditional Thai rice and the social dimension, culture, economy, and local wisdom concerning the traditional Thai rice in Ta-Thakieb District and Bang-Kla District, Chachoengsao province. (2) evaluate the chemical composition and anti-oxidant activity in rice landraces in Ta-Thakieb and Bang-Kla Districts in Chachoengsao to develop new product guidelines for food supplements and functional food. Four rice varieties are Hom-Kan-Jan, Hang-Mhoo, Leuang-Lod-Nhee, and Leuang-Song-Klong in Ta-Thakieb District. Two rice varieties are Maled-Makheua and Leuang-Na-Kwan in Bang-Kla District. The results indicated that all six rice varieties share one main component which is carbohydrate; the values range from 72.21-79.42%. Protein, fat, ash, and dietary fibre values between 0.59-9.78%, 0.61-9.41%, 0.52-7.14%, 0.67-9.25%, 1.24-10.25% and 1.59-11.21% respectively. The amylose content was around 21.03%, 11.10%, 10.25%, 7.61%, 6.28% and 5.79%, respectively. Total phenolic content of six native Thai rice was around 11.39-112.24 mg/100g. The target group of consumer in this research was the elderly (above 60 years old). From the consumer survey, the results show that most consumers are interested in instant rice products. The ratio of rice to water of the canned local rice is 1:2.34. The results from marketing survey indicated that 95.14% of consumers accepted this product with an average of 8.12 score. This score indicated that the consumer acceptance towards the products is moderate

5-Hydroxyvitamin D concentration in paediatric cancer patients from Scotland: a prospective cohort study.

Children with cancer are potentially at a high risk of plasma 25-hydroxyvitamin D (25(OH)D) inadequacy, and despite UK vitamin D supplementation guidelines their implementation remains inconsistent. Thus, we aimed to investigate 25(OH)D concentration and factors contributing to 25(OH)D inadequacy in paediatric cancer patients. A prospective cohort study of Scottish children aged 75 nmol/l). In all, eighty-two patients (median age 3·9, interquartile ranges (IQR) 1·9-8·8; 56 % males) and thirty-five controls (median age 6·2, IQR 4·8-9·1; 49 % males) were recruited. 25(OH)D inadequacy was highly prevalent in the controls (63 %; 22/35) and in the patients (64 %; 42/65) at both baseline and during treatment (33-50 %). Non-supplemented children had the highest prevalence of 25(OH)D inadequacy at every stage with 25(OH)D median ranging from 32·0 (IQR 21·0-46·5) to 45·0 (28·0-64·5) nmol/l. Older age at baseline (R -0·46; P<0·001), overnutrition (BMI≥85th centile) at 3 months (P=0·005; relative risk=3·1) and not being supplemented at 6 months (P=0·04; relative risk=4·3) may have contributed to lower plasma 25(OH)D. Paediatric cancer patients are not at a higher risk of 25(OH)D inadequacy than healthy children at diagnosis; however, prevalence of 25(OH)D inadequacy is still high and non-supplemented children have a higher risk. Appropriate monitoring and therapeutic supplementation should be implemented.