During and after hospitalisation, older adults are recommended to consume 1·2-1·5 g of protein/kg body weight per d (g/kg per d) to improve recovery. This randomised controlled trial studied the ...effectiveness of a 12-week intervention with protein-enriched foods and drinks by following-up seventy-five older patients (mean age: 76·8 (sd 6·9) years) during their first 6 months after hospital discharge. Primary outcomes were protein intake and physical performance (measured with Short Physical Performance Battery (SPPB)). Secondary outcomes for physical recovery were gait speed, chair-rise time, leg-extension strength, hand-grip strength, body weight, nutritional status (Mini Nutritional Assessment), independence in activities of daily living (ADL) and physical activity. The intervention group consumed more protein during the 12-week intervention period compared with the control group (P<0·01): 112 (sd 34) g/d (1·5 (sd 0·6) g/kg per d) v. 78 (sd 18) g/d (1·0 (sd 0·4) g/kg per d). SPPB total score, gait speed, chair-rise time, body weight and nutritional status improved at week 12 compared with baseline (time effect P<0·05), but were not different between groups. Leg-extension strength, hand-grip strength and independence in ADL did not change. In conclusion, protein-enriched products enabled older adults to increase their protein intake to levels that are higher than their required intake. In these older adults with already adequate protein intakes and limited physical activity, protein enrichment did not enhance physical recovery in the first 6 months after hospital discharge.
Iron deficiency anaemia is a Worldwide Public Health problem and the fortification of food with iron is the most cost-effective prevention strategy. The correct combination of iron form and food ...vehicle is crucial, as well as the dietary context of consumption. Combinations of iron with an enhancer of its bioavailability and avoidance of interaction with iron inhibitors are recommended. New iron fortificants, innovative complexes, coatings and nanoparticulates, and biofortification are the main research lines. Ultimately, human assays are necessary before industrial production. In this regard, precision nutrition helps to identify the vulnerable groups that, according to genotype, dietary habits, physical activity and, most recently, metagenomic profile, may benefit from a specific iron-fortified food. This review addresses the modifiers of iron bioavailability and the main aspects to take into account in the development of iron-fortified food to prevent iron deficiency.
•The potential target population that would benefit from iron-fortified foods is that at risk of iron deficiency. However, there are also segments of population at risk of iron overload.•Iron fortification involves complex technological issues, but the economic impact is very high.•Research on “omics” sciences delivers scientific results applicable to the design and production of iron-fortified food.
•Iron is the most challenging micronutrient to add to produce fortified food.•The choices of iron form, food vehicle and target population are decisive.•Other food components and meal composition may greatly modify iron bioavailability.•Safety issues are related to the iron fortified food and also to consumer protection.
Summary Background & aims Adequate protein intake is important in preventing and treating undernutrition. Hospitalized older patients are recommended to consume 1.2–1.5 g of protein per kg body ...weight per day (g/kg/d) but most of them fail to do so. Therefore, we investigated whether a range of newly developed protein-enriched familiar foods and drinks were effective in increasing protein intake of hospitalized older patients. Methods This randomized controlled trial involved 147 patients of ≥65 years (mean age: 78.5 ± 7.4 years). The control group (n = 80) received the standard energy and protein rich hospital menu. The intervention group (n = 67) received the same menu with various protein-enriched intervention products replacing regular products or added to the menu. Macronutrient intake on the fourth day of hospitalization, based on food ordering data, was compared between the two groups by using Independent T-tests and Mann Whitney U-tests. Results In the intervention group 30% of total protein was provided by the intervention products. The intervention group consumed 105.7 ± 34.2 g protein compared to 88.2 ± 24.4 g in the control group ( p < 0.01); corresponding with 1.5 vs 1.2 g/kg/d ( p < 0.01). More patients in the intervention group than in the control group reached a protein intake of 1.2 g/kg/d (79.1% vs 47.5%). Protein intake was significantly higher in the intervention group at breakfast, during the morning between breakfast and lunch, and at dinner. Conclusions This study shows that providing protein-enriched familiar foods and drinks, as replacement of regular products or as additions to the hospital menu, better enables hospitalized older patients to reach protein intake recommendations. This trial is registered on ClinicalTrials.gov , Identifier: NCT02213393.
Anaemia and malaria are both common in pregnant women in Sub-Saharan Africa. Previous evidence has shown that iron supplementation may increase malaria risk. In this observational cohort study, we ...evaluated P. falciparum pathogenesis in vitro in RBCs from pregnant women during their 2nd and 3rd trimesters. RBCs were collected and assayed before (n = 327), 14 days (n = 82), 49 days (n = 112) and 84 days (n = 115) after iron supplementation (60 mg iron as ferrous fumarate daily). P. falciparum erythrocytic stage growth in vitro is reduced in anaemic pregnant women at baseline, but increased during supplementation. The elevated growth rates parallel increases in circulating CD71-positive reticulocytes and other markers of young RBCs. We conclude that Plasmodium growth in vitro is associated with elevated erythropoiesis, an obligate step towards erythroid recovery in response to supplementation. Our findings support current World Health Organization recommendations that iron supplementation be given in combination with malaria prevention and treatment services in malaria endemic areas.
Mineral phosphorus (P) fertilizers support high crop yields and contribute to feeding the teeming global population. However, complex edaphic processes cause P to be immobilized in soil, hampering ...its timely and sufficient availability for uptake by plants. The resultant low use efficiency of current water-soluble P fertilizers creates significant environmental and human health problems. Current practices to increase P use efficiency have been inadequate to curtail these problems. We advocate for the understanding of plant physiological processes, such as physiological P requirement, storage of excess P as phytate, and plant uptake mechanisms, to identify novel ways of designing and delivering P fertilizers to plants for improved uptake. We note the importance and implications of the contrasting role of micronutrients such as zinc and iron in stimulating P availability under low soil P content, while inhibiting P uptake under high P fertilization; this could provide an avenue for managing P for plant use under different P fertilization regimes. We argue that the improvement of the nutritional value of crops, especially cereals, through reduced phytic acid and increased zinc and iron contents should be among the most important drivers toward the development of innovative fertilizer products and fertilization technologies. In this paper, we present various pathways in support of this argument. Retuning P fertilizer products and application strategies will contribute to fighting hunger and micronutrient deficiencies in humans. Moreover, direct soil P losses will be reduced as a result of improved P absorption by plants.
Increased weight gain during infancy is a risk factor for obesity and related diseases in later life. The aim of the present study was to investigate the association between socioeconomic status ...(SES) and weight gain during infancy, and to identify the factors mediating the association between SES and infant weight gain.
Subjects were 2513 parent-child dyads participating in a cluster randomized controlled intervention study. Family SES was indexed by maternal education level. Weight gain in different time windows (infant age 0-3, 0-6, and 6-12 months) was calculated by subtracting the weight for age z-score (WAZ) between the two time-points. Path analysis was performed to examine the mediating pathways linking SES and infant weight gain.
On average, infants of low-educated mothers had a lower birth weight and caught-up at approximately 6 months. In the period of 0-6 months, infants with low-educated mothers had an 0.42 (95% CI 0.27-0.57) higher gain in weight for age z-score compared to children with high-educated mothers. The association between maternal education level and increased infant weight gain in the period of 0-6 months can be explained by infant birth weight, gestational age at child birth, duration of breastfeeding, and age at introduction of complementary foods. After adjusting all the mediating factors, there was no association between maternal education level and infant weight gain.
Infants with lower SES had an increased weight gain during the first 6 months of infancy, and the effect can be explained by infant birth weight, gestational age at child birth, and infant feeding practices.
As misreporting, mostly under-reporting, of dietary intake is a generally known problem in nutritional research, we aimed to analyse the association between selected determinants and the extent of ...misreporting by the duplicate portion method (DP), 24 h recall (24hR) and FFQ by linear regression analysis using the biomarker values as unbiased estimates.
For each individual, two DP, two 24hR, two FFQ and two 24 h urinary biomarkers were collected within 1·5 years. Also, for sixty-nine individuals one or two doubly labelled water measurements were obtained. The associations of basic determinants (BMI, gender, age and level of education) with misreporting of energy, protein and K intake of the DP, 24hR and FFQ were evaluated using linear regression analysis. Additionally, associations between other determinants, such as physical activity and smoking habits, and misreporting were investigated.
The Netherlands.
One hundred and ninety-seven individuals aged 20-70 years.
Higher BMI was associated with under-reporting of dietary intake assessed by the different dietary assessment methods for energy, protein and K, except for K by DP. Men tended to under-report protein by the DP, FFQ and 24hR, and persons of older age under-reported K but only by the 24hR and FFQ. When adjusted for the basic determinants, the other determinants did not show a consistent association with misreporting of energy or nutrients and by the different dietary assessment methods.
As BMI was the only consistent determinant of misreporting, we conclude that BMI should always be taken into account when assessing and correcting dietary intake.
>bold<>italic<Background:>/italic<>/bold< Following a timely update process, the nutrition societies of Germany, Austria, and Switzerland (D-A-CH) revised the reference values for the intake of ...protein in 2017. The Working Group conducted a structured literature search in PubMed considering newly published papers (2000– 2017). >bold<>italic<Summary:>/italic<>/bold< For infants < 4 months, the estimated values were set based on the protein intake via breast milk. Reference values for infants > 4 months, children, adolescents, pregnant, and lactating women were calculated using the factorial method considering both requirement for growth and maintenance. For adults, reference values were derived from nitrogen balance studies; for seniors (> 65 years), reports on metabolic and functional parameters under various protein intakes were additionally considered. Reference values (g protein/kg body weight per day) were set as follows: infants < 4 months: 2.5–1.4, children: 1.3–0.8, adults < 65 years: 0.8, adults > 65 years: 1.0. >bold<>italic<Key Messages:>/italic<>/bold< The reference values for infants, children, adolescents, and adults < 65 years are essentially unchanged compared to recently published values. Scientifically reliable data published between 2000 and 2017 guided the D-A-CH Working Group to set a higher estimated value for adults > 65 years. Since the energy consumption continuously decreases with age, this new estimated protein intake value might be a challenge for the introduction of food-based nutrition concepts for older people.
To assess the prevalence of vitamin D deficiency in Dutch athletes and to define the required dosage of vitamin D3 supplementation to prevent vitamin D deficiency over the course of a year.
Blood ...samples were collected from 128 highly trained athletes to assess total 25(OH)D concentration. Of these 128 athletes, 54 male and 48 female athletes (18-32 years) were included in a randomized, double blind, dose-response study. Athletes with either a deficient (<50 nmol/l) or an insufficient (50-75 nmol/l) 25(OH)D concentration were randomly assigned to take 400, 1100 or 2200 IU vitamin D3 per day orally for 1 year. Athletes who had a total 25(OH)D concentration above 75 nmol/l at baseline continued with the study protocol without receiving vitamin D supplements. Serum total 25(OH)D concentration was assessed every 3 months, as well as dietary vitamin D intake and sunlight exposure.
Nearly 70% of all athletes showed an insufficient (50-75 nmol/l) or a deficient (<50 nmol/l) 25(OH)D concentration at baseline. After 12 months, serum 25(OH)D concentration had increased more in the 2200 IU/day group (+50±27 nmol/l) than the sufficient group receiving no supplements (+4±17 nmol/l; P<0.01) and the 1100 IU/day group (+25±23 nmol/l; P<0.05). Supplementation with 2200 IU/day vitamin D resulted in a sufficient 25(OH)D concentration in 80% of the athletes after 12 months.
Vitamin D deficiency is highly prevalent in athletes. Athletes with a deficient or an insufficient 25(OH)D concentration can achieve a sufficient 25(OH)D concentration within 3 months by taking 2200 IU/day.
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