Foods, fortificants, and supplements: Where do Americans get their nutrients?

Effects of Periodic Religious Fasting for Decades on Nutrient Intakes and the Blood Biochemical Profile

The aim of the present study was to examine differences and correlations in nutrient intakes and serum parameters related to nutrient intake (lipid profile, vitamins, and trace elements) in 200 lifelong Christian Orthodox Church (COC) fasters with periodic abstinence from certain foods (predominantly of animal origin) for approximately half of the year and 200 non-fasting controls, all of whom did not take dietary supplements. Nutrient intakes were assessed through three-day dietary recalls. Blood samples were drawn for the analysis of potential biomarkers of nutrient intake. Fasters had lower energy intake, due to lower fat and protein intake, compared to non-fasters (p < 0.05). Fasters also had lower intakes of vitamins A, B₁, B₂, B₆, B₁₂, D, folate, pantothenate, sodium, calcium, zinc, and phosphorus. Most participants (in both groups) did not meet the recommended dietary allowances of most vitamins and elements. Most serum biochemical parameters did not reflect the differences in nutrient intakes between groups, and none exhibited a correlation coefficient above 0.5 with nutrient intakes. Our findings suggest that COC fasting is associated with reduced intake of many nutrients, although this does not seem to have an impact on the blood biochemical profile.

The Role of Fortified and Enriched Refined Grains in the US Dietary Pattern: A NHANES 2009-2016 Modeling Analysis to Examine Nutrient Adequacy

Background: While dietary recommendations call for greater whole-grain intake and reduced refined grain consumption, there are limited peer-reviewed studies examining the influence of fortified/enriched refined grains on nutrient adequacy. Methods: A modeling analysis using data from National Health and Nutrition Examination Survey (NHANES) 2009-2016 estimated usual daily intake of shortfall nutrients for Dietary Guidelines for Americans (DGA) in the current dietary pattern and when specific percentages of fortified/enriched refined grain foods (bread, ready-to-eat cereals, and all-grained foods) were removed from the diet (19-50-year-old adults, N = 11,169; 51-99-year-old adults, N = 9,641). Results: While American adults are currently falling short of nutrient recommendations, eliminating 25, 50, and 100% of all grains consumed in the US dietary pattern resulted in a greater percentage of adults not meeting recommendations for several shortfall nutrients, including dietary fiber, folate DFE, iron, and magnesium. Removal of all grains led to a reduced energy intake by ~10% in both age groups examined. Currently, ~3.8% of 19-50-year-old adults meet the adequate intake (AI) for dietary fiber. Removal of 25, 50, and 100% of grains from the diet resulted in 2.6 ± 0.3, 1.8 ± 0.2, and 0.7 ± 0.1% of adults exceeded the AI for dietary fiber, respectively. Similarly, 11.0 and 13.8% of younger and older adults, respectively, fall short of folate, DFE recommendations with the current diet. Following the removal of 100% of grains from the diet, 43.4 ± 1.1 and 56.2 ± 1.0%, respectively, were below the estimated average requirement (EAR) for folate DFE. For iron, current dietary pattern consumption shows 8.4% and 0.8% of younger and older adults, respectively, are not meeting iron recommendations, however, removal of 100% of grains from the diet results in nearly 10 and 22% falling short of the EAR. Currently, about 51 and 54% of younger and older adults are below the EAR for magnesium; however, with the removal of 100% of grains, 68 and 73%, respectively, fall below the EAR. Conclusion: Removal of specific refined grains led to an increased percentage of Americans not meeting recommendations for several shortfall nutrients, including dietary fiber, folate, iron, and magnesium.

Vitamins in Cereals: A Critical Review of Content, Health Effects, Processing Losses, Bioaccessibility, Fortification, and Biofortification Strategies for Their Improvement

Around the world, cereals are stapled foods and good sources of vitamins A, B, and E. As cereals are inexpensive and consumed in large quantities, attempts are being made to enrich cereals using fortification and biofortification in order to address vitamin deficiency disorders in a vulnerable population. The processing and cooking of cereals significantly affect vitamin content. Depending on grain structure, milling can substantially reduce vitamin content, while cooking methods can significantly impact vitamin retention and bioaccessibility. Pressure cooking has been reported to result in large vitamin losses, whereas minimal vitamin loss was observed following boiling. The fortification of cereal flour with vitamins B1, B2, B3, and B9, which are commonly deficient, has been recommended; and in addition, region-specific fortification using either synthetic or biological vitamins has been suggested. Biofortification is a relatively new concept and has been explored as a method to generate vitamin-rich crops. Once developed, biofortified crops can be utilized for several years. A recent cereal biofortification success story is the enrichment of maize with provitamin A carotenoids.

The effect of consuming voluntarily fortified food and beverages on usual nutrient intakes in the Canadian population

BACKGROUND

In Canada, regulatory changes have expanded marketing opportunities for voluntarily fortified products (VFPs), with micronutrient additions permitted at levels well in excess of human requirements.

OBJECTIVE

To examine how the consumption of VFPs relates to usual nutrient intakes in the Canadian population.

DESIGN

The 2015 Canadian Community Health Survey comprises single 24-h dietary intake recalls on a population-representative sample of 20,487 individuals aged 1 year and older, with second recalls on a subset of 7,608. The intake data included 15 food codes denoting VFP (e.g. energy drinks, fortified beverages, cereals, and bars). We assessed VFP consumption and estimated usual intake distributions for riboflavin, niacin, zinc, and vitamins A, B6, B12, and C for VFP consumers and non-consumers 14-50 years old (n = 8,442) using the National Cancer Institute method. We applied the 'shrink and add' method to estimate usual intakes among supplement users and assessed apparent benefits and risks by comparing usual intake distributions to EARs and ULs.

RESULTS

Only 2.4% of the population reported any consumption of VFP on the first 24-h recall. VFP consumers were overrepresented in the upper quartile of population intake distributions for niacin, riboflavin, vitamin B6, vitamin B12, and zinc. The median usual intakes of VFP consumers were 24-111% higher than the median usual intakes of non-consumers, and VFP consumers had significantly lower prevalence of inadequacy for riboflavin and vitamins A, B6, B12, and C. Irrespective of VFP consumption, usual intake distributions reached the ULs for vitamin A and zinc with the addition of supplement intakes.

DISCUSSION

Given the limited differentiation of VFP in this survey, we have likely underestimated nutrient exposure levels.

CONCLUSIONS

VFP consumption was associated with elevated usual nutrient intakes, but we found limited evidence that it protected consumers from nutrient inadequacies or propelled intakes above tolerable upper levels.

Efficacy of vitamin D food fortification and biofortification in children and adults: a systematic review protocol

OBJECTIVE

The objective of this review is to assess the effect of vitamin D food fortification and biofortification on serum 25-hydroxyvitamin D (25(OH)D) concentrations.

INTRODUCTION

Vitamin D deficiency is a global issue with considerable implications for public health. Many people do not receive sufficient sun exposure for adequate endogenous vitamin D synthesis, nor sufficient dietary vitamin D to meet their requirements. Increasing sun exposure may increase the risk of skin cancer, and vitamin D supplementation is not favored as a population-wide solution. Previous systematic reviews have shown a dose-dependent effect of vitamin D-fortified foods on circulating 25(OH)D concentrations. However, previous reviews did not investigate the efficacy of vitamin D fortification and biofortification in children, and several new fortification and biofortification trials in adults have been published since these earlier systematic reviews were conducted.

INCLUSION CRITERIA

This review will consider randomized controlled trials that investigate the effect of vitamin D food fortification and biofortification on serum 25(OH)D concentrations in children and adults.

METHODS

CINAHL, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PubMed will be searched for relevant studies published in English. Following a screening of titles and abstracts by a single author, relevant full-text articles will be independently reviewed by two authors. Two authors will independently assess methodological quality using the JBI critical appraisal checklist for randomized controlled trials. Data will be independently extracted by two authors. A meta-analysis will be conducted, and heterogeneity will be statistically tested.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020145497.

Total estimated usual nutrient intake and nutrient status biomarkers in women of childbearing age and women of menopausal age

BACKGROUND

Women of childbearing age (WCBA) and women of menopausal age (WMENO) have distinct nutritional needs. Understanding nutrient intake and status in these life stages is critical for tailoring dietary recommendations.

OBJECTIVES

The objectives of this study were to evaluate total estimated usual nutrient intakes from food and food plus supplements and to compare these to established recommendations for WCBA and WMENO life stages and examine associations between self-reported estimated usual intakes and nutrient status biomarkers.

METHODS

Twenty-four-hour dietary recall data from 2011-2016 NHANES were used to estimate usual intake of nutrients from food and food plus supplements for WCBA (aged 15-44 y, n = 4,134) and WMENO (aged 40-65 y, n = 3,438). Estimates of mean usual intake were derived and compared across clinically defined nutrient biomarker categories.

RESULTS

Both young (aged 15-30 y) and older (aged 31-44 y) WCBA had intakes from food below the Estimated Average Requirement (EAR) for calcium (49% and 44%, respectively), magnesium (62%, 44%), and vitamins A (50%, 44%), C (47%, 46%), D (>97%, >97%), and E (92%, 88%). Similarly, perimenopausal (aged 40-50 y) and menopausal (aged 51-65 y) women had intakes from food below the EAR for calcium (48% and 74%, respectively), magnesium (50%, 49%), and vitamins A (44%, 37%), C (44%, 41%), D (>97%, >97%), and E (88%, 86%). Nutrient gaps decreased with supplement usage. For folate, vitamins D and B-12, and DHA, women in the lowest biomarker category (indicating increased risk of deficiency) had significantly lower intake from food (315.2 ± 25.9 compared with 463.8 ± 5.2 µg dietary folate equivalents, 3.5 ± 0.1 compared with 4.2 ± 0.1 µg, 3.6 ± 0.2 compared with 4.3 ± 0.1 µg, and 0.037 ± 0.005 compared with 0.070 ± 0.006 g, respectively; P < 0.01) of the corresponding nutrient compared with the highest biomarker category.

CONCLUSIONS

Substantial percentages of WCBA and WMENO are not meeting recommendations for multiple nutrients, whereas supplement usage partially fills nutrient gaps. Dietary intake was positively associated with most nutrient status biomarkers. Specific guidance is needed to ensure adequate nutrient intakes and nutrient status during these critical life stages.

Pumpkin, Cauliflower and Broccoli as New Carriers of Thiamine Compounds for Food Fortification

The aim of the study is to explore the possibility of vegetables being used as carriers of thiamine. The influence of carrier type (thiamine hydrochloride—TCh and thiamine pyrophosphate—TP) for the thiamine stability were investigated. Two varieties of pumpkin, Muscat and Hokkaido, as well as Cauliflower and Broccoli, were used as a matrix for the thiamine applied. The impregnated and freeze-dried vegetables were stored (230 days) with changing access to light (access to and restriction of light) and temperature (21 °C and 40 °C). The analyzed carriers were also used in the production of gnocchi dumplings. The content of thiamine was analyzed using the thiochromium method. In the study, consumer tests (n = 199) and sensory profiling were used to assess the impact of thiamine carriers on the sensory quality of gnocchi dumplings. It was found that the introduction of dried vegetables at the level of 30% allows for high sensory desirability of analyzed products, as well as suggesting the possibility of their frequent consumption. Such a product could potentially become an alternative to pork meat as a good source of thiamine. However, it should be noted that the thiamine losses may occur during the storage of dried vegetables and their culinary preparation.

Dietary magnesium intake in relation to body mass index and glycemic indices in middle school students from the HEALTHY Study

BACKGROUND

Data on dietary magnesium intake on the risk of type 2 diabetes mellitus (T2DM) among children and adolescents is limited.

AIM

We examined whether dietary magnesium intake was related to body mass index (BMI) percentile, and glycemic indices at baseline and at end of the HEALTHY Study for both intervention and control schools. The HEALTHY Study was a multi-component, school-based intervention, to prevent T2DM in children and adolescents from 6th to 8th grades.

METHODS

A secondary data analyses of 2181 ethnically diverse students with completed dietary records, BMI percentile, and plasma insulin and glucose concentrations at baseline (6th grade) and end of study (8th grade) were included from the HEALTHY Study. Dietary magnesium intake was self-reported using the Block Kids Food Frequency Questionnaire. A hierarchical multiple regression model was used to determine the relationships between dietary magnesium intake, BMI percentile, and glycemic indices at baseline and end of the HEALTHY Study, adjusting for magnesium intake from supplements, total energy intake, and fitness level.

RESULTS

Dietary magnesium intake was related to BMI percentile at baseline and at end of the HEATHY Study (β = -0.05, 95% CI = -0.02 to 0, p = 0.04; β = -0.06, 95% CI = -0.02 to -0.003, p = 0.004); R ² [regression coefficient effect size] = 0.03; R ² = 0.06). Dietary magnesium intake was not related to plasma insulin and glucose concentrations at baseline and end of the HEALTHY Study.

CONCLUSION

Dietary magnesium intake was inversely related to BMI percentile among middle school students from the HEALTHY Study. Research is required to evaluate the dose-response relationship between fruit and vegetable consumption (good sources of magnesium) and risk of T2DM in children and adolescents. This relationship also needs to be explored among different BMI categories.

Do Dietary Supplements Improve Perceived Health Well-Being? Evidence from Korea

This study analyzes the self-reported intake of dietary supplements (DS) and their effects on perceived health well-being from a survey with 1210 adult respondents in Korea. To account for selectivity bias from observable confounders, we use a propensity score matching (PSM) model. Our findings show that demographics, health concerns, family history of disease, frequency of hospital visits, and regular exercise are positively associated with intake of DS among consumers. Results from PSM show that the intake of DS leads to significant improvements in perceived health well-being among DS takers relative to DS non-takers regardless of gender, urban residence, having self-reported diseases or not. The paper concludes with implications for policies that promote intake of DS in Korea.

Mg2+ Transporters in Digestive Cancers

Despite magnesium (Mg²⁺) representing the second most abundant cation in the cell, its role in cellular physiology and pathology is far from being elucidated. Mg²⁺ homeostasis is regulated by Mg²⁺ transporters including Mitochondrial RNA Splicing Protein 2 (MRS2), Transient Receptor Potential Cation Channel Subfamily M, Member 6/7 (TRPM6/7), Magnesium Transporter 1 (MAGT1), Solute Carrier Family 41 Member 1 (SCL41A1), and Cyclin and CBS Domain Divalent Metal Cation Transport Mediator (CNNM) proteins. Recent data show that Mg²⁺ transporters may regulate several cancer cell hallmarks. In this review, we describe the expression of Mg²⁺ transporters in digestive cancers, the most common and deadliest malignancies worldwide. Moreover, Mg²⁺ transporters’ expression, correlation and impact on patient overall and disease-free survival is analyzed using Genotype Tissue Expression (GTEx) and The Cancer Genome Atlas (TCGA) datasets. Finally, we discuss the role of these Mg²⁺ transporters in the regulation of cancer cell fates and oncogenic signaling pathways.

Milk consumption and multiple health outcomes: umbrella review of systematic reviews and meta-analyses in humans

In order to recapitulate the best available evidence of milk consumption and multiple health-related outcomes, we performed an umbrella review of meta-analyses and systematic reviews in humans. Totally, 41 meta-analyses with 45 unique health outcomes were included. Milk consumption was more often related to benefits than harm to a sequence of health-related outcomes. Dose–response analyses indicated that an increment of 200 ml (approximately 1 cup) milk intake per day was associated with a lower risk of cardiovascular disease, stroke, hypertension, colorectal cancer, metabolic syndrome, obesity and osteoporosis. Beneficial associations were also found for type 2 diabetes mellitus and Alzheimer's disease. Conversely, milk intake might be associated with higher risk of prostate cancer, Parkinson’s disease, acne and Fe-deficiency anaemia in infancy. Potential allergy or lactose intolerance need for caution. Milk consumption does more good than harm for human health in this umbrella review. Our results support milk consumption as part of a healthy diet. More well-designed randomized controlled trials are warranted.

Current calcium fortification experiences: a review

Low dietary calcium is very common in many populations, contributing to nutritional rickets/osteomalacia in children/adults and increasing the risk of several health problems. Calcium is a nutrient of concern as the recommended nutrient requirements are difficult to meet in the absence of dairy products. The provision of culturally acceptable calcium-fortified foods may improve calcium intake when it is a feasible and cost-effective strategy in a particular setting. This landscape review was conducted in 2019 and describes current calcium fortification efforts and lessons learned from these experiences. Worldwide, the United Kingdom is the only country where calcium fortification of wheat flour is mandatory. It is estimated that this fortified staple ingredient contributes to 13-14% of calcium intake of the British population. Other items voluntary fortified with calcium include maize flour, rice, and water. Current calcium fortification programs may lack qualified personnel/training, clear guidelines on implementation, regulation, monitoring/evaluation, and functional indicators. Also, the cost of calcium premix is high and the target groups may be hard to reach. There is a lack of rigorous evaluation, particularly in settings with multiple micronutrient programs implemented simultaneously, with low quality of the evidence. Further research is needed to assess the impact of calcium fortification programs.

Vitamins are Indeed Vital Amines: A Discussion of 3 Deficiencies With Neurologic Manifestations

Optimal functioning of the human nervous system depends on a constant supply of nutrients, vitamins, and minerals. In the developed world, nutritional deficiencies are relatively rare and infrequently present with neurologic manifestations. These neurologic disorders can be mistaken for inflammatory and/or autoimmune phenomena. This manuscript describes 2 pediatric cases with neurologic signs/symptoms arising from vitamin deficiencies-(1) optic neuropathy and (2) Wernicke encephalopathy associated with a Guillain-Barre-like pattern of weakness. The 2 cases and the subsequent discussion of vitamin A, B1, and B12 deficiencies underscore the value of taking a thorough dietary history and emphasize risk factors for these 3 nutritional deficiencies.

Phosphate Metabolism in Health and Disease

Phosphorus, a 5A element with atomic weight of 31, comprises just over 0.6% of the composition by weight of plants and animals. Three isotopes are available for studying phosphorus metabolism and kinetics. ³¹P is stable, whereas the radioactive isotope ³³P has a half-life of 25 days and ³²P has a half-life of 14 days. Phosphate ester and phosphoanhydride are common chemical linkages and phosphorus is a key element in organic molecules involved in a wide variety of essential cellular functions. These include biochemical energy transfer via adenosine triphosphate (ATP), maintenance of genetic information with nucleotides DNA and RNA, intracellular signaling via cyclic adenosine monophosphate (cAMP), and membrane structural integrity via glycerophospholipids. However, this review focuses on the metabolism of inorganic phosphorus (Pi) acting as a weak acid. Phosphoric acid has all three hydrogens attached to oxygen and is a weak diprotic acid. It has 3 pKa values: pH 2.2, pH 7.2, and pH 12.7. At physiological pH of 7.4, Pi exists as both H₂PO₄^(-) and HPO₄^(2-) and acts as an extracellular fluid (ECF) buffer. Pi is the form transported across tissue compartments and cells. Measurement of Pi in biological fluids is based on its reaction with ammonium molybdate which does not measure organic phosphorus. In humans, 80% of the body phosphorus is present in the form of calcium phosphate crystals (apatite) that confer hardness to bone and teeth, and function as the major phosphorus reservoir (Fig. 1). The remainder is present in soft tissues and ECF. Dietary phosphorus, comprising both inorganic and organic forms, is digested in the upper gastrointestinal tract. Absorbed Pi is transported to and from bone, skeletal muscle and soft tissues, and kidney at rates determined by ECF Pi concentration, rate of blood flow, and activity of cell Pi transporters (Fig. 2). During growth, there is net accretion of phosphorus, and with aging, net loss of phosphorus occurs. The bone phosphorus reservoir is depleted and repleted by overall phosphorus requirement. Skeletal muscle is rich in phosphorus used in essential biochemical energy transfer. Kidney is the main regulator of ECF Pi concentration by virtue of having a tubular maximum reabsorptive capacity for Pi (TmPi) that is under close endocrine control. It is also the main excretory pathway for Pi surplus which is passed in urine. Transcellular and paracellular Pi transports are performed by a number of transport mechanisms widely distributed in tissues, and particularly important in gut, bone, and kidney. Pi transporters are regulated by a hormonal axis comprising fibroblast growth factor 23 (FGF23), parathyroid hormone (PTH), and 1,25 dihydroxy vitamin D (1,25D). Pi and calcium (Ca) metabolism are intimately interrelated, and clinically neither can be considered in isolation. Diseases of Pi metabolism affect bone as osteomalacia/rickets, soft tissues as ectopic mineralization, skeletal muscle as myopathy, and kidney as nephrocalcinosis and urinary stone formation. Fig. 1 Content of phosphorus in human adult: skeleton, soft tissue, and extracellular fluid (grams, log scale). Corresponding data for calcium are shown for comparison Fig. 2 Phosphate (Pi) transport to and from tissue compartments in mg/24 h. At a dietary phosphorus of 1400 mg, 1120 mg is absorbed in upper intestine to the ECF, 210 mg returned to intestine by endogenous secretion, resulting in 910 mg net Pi absorption and 490 mg fecal excretion. At bone, 180 mg is deposited by bone formation and 180 mg return to the ECF by bone resorption. At kidney, 5040 mg is filtered at the glomerulus and 4130 mg return to the ECF by tubular reabsorption with 910 mg excreted in the urine. In soft tissue, Pi is exchanged between ECF and cells.

High folic acid or folate combined with low vitamin B-12 status: potential but inconsistent association with cognitive function in a nationally representative cross-sectional sample of US older adults participating in the NHANES

BACKGROUND

Potential safety concerns relative to impaired cognitive function may exist when high folic acid exposures are combined with low vitamin B-12 status.

OBJECTIVES

We aimed to examine the relation of the coexistence of high folate and low vitamin B-12 status with cognitive function, utilizing various definitions of "high" folate status.

METHODS

Cross-sectional data from older adults (≥60 y; n = 2420) from the 2011-2014 NHANES were analyzed. High folate status was defined as unmetabolized serum folic acid (UMFA) > 1 nmol/L or serum total folate > 74.1 nmol/L, and low vitamin B-12 status as methylmalonic acid > 271 nmol/L or serum vitamin B-12 < 150 pmol/L. Logistic regression models estimated ORs of scoring low on 1 of 4 cognitive tests: the Digit Symbol Substitution Test (DSST), the Consortium to Establish a Registry for Alzheimer's Disease Delayed Recall (CERAD-DR) and Word Learning tests, and the Animal Fluency test (AF).

RESULTS

A significant interaction was observed relative to scoring low on the DSST (<34; UMFA; P-interaction = 0.0071) and AF (serum folate; P-interaction = 0.0078) for low vitamin B-12 and high folate status. Among those with low vitamin B-12, high UMFA or high serum total folate was associated with higher risk of scoring low on the DSST (OR: 2.16; 95% CI: 1.05, 4.47) and the AF (OR: 1.93; 95% CI: 1.08, 3.45). Among those with "normal" vitamin B-12, higher UMFA or serum total folate was protective on the CERAD-DR. In noninteraction models, when high folate and normal vitamin B-12 status was the reference group, low vitamin B-12 combined with high UMFA was associated with greater risk based on the DSST (<34, OR: 2.87; 95% CI: 1.85, 4.45; <40, OR: 2.22; 95% CI: 1.31, 3.75) and AF (OR: 1.97; 95% CI: 1.30, 2.97); but low vitamin B-12 and lower UMFA (OR: 1.69; 95% CI: 1.16, 2.47) was also significantly associated for DSST < 40 risk.

CONCLUSIONS

Low vitamin B-12 was associated with cognitive impairment both independently and in an interactive manner with high folate for certain cognitive performance tests among older adults.

The Role of Metal Oxide Nanoparticles, Escherichia coli, and Lactobacillus rhamnosus on Small Intestinal Enzyme Activity

Engineered nanomaterials (ENMs) have become common in the food industry, which motivates the need to evaluate ENM effects on human health. Gastrointestinal (GI) in vitro models (e.g. Caco-2, Caco-2/HT29-MTX) have been used in nanotoxicology research. However, the human gut environment is composed of both human cells and the gut microbiota. The goal of this study is to increase the complexity of the Caco-2/HT29-MTX in vitro model by co-culturing human cells with the Gram-positive, commensal Lactobacillus rhamnosus or the Gram-negative, opportunistic Escherichia coli; with the hypothesis that the presence of bacteria would ameliorate the effects of exposure to metal oxide nanoparticles (NPs) such as iron oxide (Fe2O3), silicone dioxide (SiO2), titanium dioxide (TiO2), or zinc oxide (ZnO). To understand this relationship, Caco-2/HT29-MTX cell barriers were acutely co-exposed (4 hours) to bacteria and/or NPs (pristine or in vitro digested). The activity of the brush border membrane (BBM) enzymes intestinal alkaline phosphatase (IAP), aminopeptidase-N (APN), sucrase isomaltase (SI) and the basolateral membrane enzyme (BLM) Na+/K+ ATPase were assessed. Findings show that (i) the human digestion process alters the physicochemical properties of NPs, (ii) large agglomerates of NPs remain entrapped on the apical side of the intestinal barrier, which (iii) affects the activity of BBM enzymes. Interestingly, some NPs effects were attenuated in the presence of either bacterial strains. Confocal microscopy detected bacteria-NPs interactions, which may impede the NP-intestinal cell contact. These results highlight the importance of improving in vitro models to closely mimic the complexities of the human body.

Ball ME, McDonald E, Hull GLJ, Danaher M, Cashman KD. Biofortification of Chicken Eggs with Vitamin K-Nutritional and Quality Improvements

National nutrition surveys have shown that over half of all adults in Ireland, the United Kingdom (UK), and the United States of America (USA) have low vitamin K intakes. Thus, dietary strategies to improve vitamin K intakes are needed, and vitamin K biofortification of food may be one food-based approach. The primary aim of our study was to establish whether increasing the vitamin K3 content of hen feed can increase the vitamin K content of eggs, and the secondary aims were to examine the effects on hen performance parameters, as well as egg and eggshell quality parameters. A 12 week hen feeding trial was conducted in which Hyline chickens were randomized into four treatment groups (n = 32/group) and fed diets containing vitamin K3 (as menadione nicotinamide bisulfite) at 3 (control), 12.9, 23.7, and 45.7 mg/kg feed. Vitamin K1, menaquinone (MK)-4, MK-7, and MK-9 were measured in raw whole eggs via a liquid chromatography tandem mass spectrometry method. MK-4 was the most abundant form of vitamin K (91-98%) found in all eggs. Increasing the vitamin K3 content of hen feed over the control level significantly (p < 0.001) enhanced the MK-4 content of eggs (mean range: 46-51 µg/100 g, representing ~42-56% of US Adequate Intake values). Vitamin K biofortification also led to significant (p < 0.05) increases in the yellowness of egg yolk and in eggshell weight and thickness, but no other changes in egg quality or hen performance parameters. In conclusion, high-quality vitamin K-biofortified eggs can be produced with at least double the total vitamin K content compared to that in commercially available eggs.

Going to the roots of reduced magnesium dietary intake: A tradeoff between climate changes and sources

Magnesium is essential in plants where it is associated with chlorophyll pigments and serves as a cofactor of enzymes implicated in photosynthesis and metabolism. It is an essential nutrient for animals, involved in hundreds metabolic reaction and crucial for the biological activity of ATP. Not surprisingly, magnesium deficiency is detrimental for the health of plants and animals. In humans, subclinical magnesium deficiency is common and generates chronic inflammation, which is the common denominator of a wide range of mental and physical health problems from metabolic diseases to cognitive impairment, from osteopenia and sarcopenia to depression. It is ascertained that magnesium content in fruits and vegetables dropped in the last fifty years, and about 80% of this metal is lost during food processing. As a consequence, a large percentage of people all over the world does not meet the minimum daily magnesium requirement. In this scoping review, we summarize how agronomic and environmental factors, including global warming, affect magnesium content and availability in the soil and, consequently, in the food chain, with the aim of attracting the interest of botanists, agronomists, animal and human nutritionists and physicians to work on a strategy that grants adequate magnesium intake for everybody.

Vitamin D status in children and adults in Sweden: dietary intake and 25-hydroxyvitamin D concentrations in children aged 10-12 years and adults aged 18-80 years

The study aimed to estimate vitamin D intake and plasma/serum 25-hydroxyvitamin D (25(OH)D) concentrations, investigate determinants of 25(OH)D concentrations and compare two 25(OH)D assays. We conducted two nationwide cross-sectional studies in Sweden with 206 school children aged 10-12 years and 1797 adults aged 18-80 years (n 268 provided blood samples). A web-based dietary record was used to assess dietary intake. Plasma/serum 25(OH)D was analysed by liquid chromatography-mass spectrometry (LC-MS) and immunoassay in adults and LC-MS/MS in children. Most participants reported a vitamin D intake below the average requirement (AR), 16 % of children and 33 % of adults met the AR (7⋅5 μg). In adults, plasma 25(OH)D below 30 and 50 nmol/l were found in 1 and 18 % of participants during the summer period and in 9 and 40 % of participants during the winter period, respectively. In children, serum 25(OH)D below 30 and 50 nmol/l were found in 5 and 42 % of participants (samples collected March-May), respectively. Higher 25(OH)D concentrations were associated with the summer season, vacations in sunny locations (adults), and dietary intake of vitamin D and use of vitamin D supplements, while lower concentrations were associated with a higher BMI and an origin outside of Europe. Concentrations of 25(OH)D were lower using the immunoassay than with the LC-MS assay, but associations with dietary factors and seasonal variability were similar. In conclusion, vitamin D intake was lower than the AR, especially in children. The 25(OH)D concentrations were low in many participants, but few participants had a concentration below 30 nmol/l.

Do Refined Grains Have a Place in a Healthy Dietary Pattern: Perspectives from an Expert Panel Consensus Meeting

Although dietary guidance recommends increasing consumption of whole grains and concurrently limiting consumption of refined and/or enriched grain foods, emerging research suggests that certain refined grains may be part of a healthy dietary pattern. A scientific expert panel was convened to review published data since the release of 2015 dietary guidance in defined areas of grain research, which included nutrient intakes, diet quality, enrichment/fortification, and associations with weight-related outcomes. Based on a 1-d roundtable discussion, the expert panel reached consensus that 1) whole grains and refined grains can make meaningful nutrient contributions to dietary patterns, 2) whole and refined grain foods contribute nutrient density, 3) fortification and enrichment of grains remain vital in delivering nutrient adequacy in the American diet, 4) there is inconclusive scientific evidence that refined grain foods are linked to overweight and obesity, and 5) gaps exist in the scientific literature with regard to grain foods and health.

Pasta Consumption Is Linked to Greater Nutrient Intakes and Improved Diet Quality in American Children and Adults, and Beneficial Weight-Related Outcomes Only in Adult Females

The present analyses evaluated associations between pasta consumption, nutrient intakes, and diet quality in U.S. children (2–18 years-old; N = 323) and adults (≥19 years-old; N = 400) using the US National Health and Nutrition Examination Survey, 2001–2012 dataset. An additional aim included assessing associations with pasta consumption and weight-related outcomes in adults. Consumption of dry, domestic, and imported wheat pasta/noodles without eggs defined pasta consumers. Energy intake was similar when comparing pasta consumers vs. non-consumers of pasta. Pasta consumers had increased daily intake of dietary fiber (16 ± 0.6 vs. 13 ± 0.1 g/d, p < 0.0001; 21 ± 0.8 vs. 16 ± 0.1 g/d, p < 0.0001), folate, DFE (701 ± 30 vs. 528 ± 5 μg/d, p < 0.0001; 733 ± 42 vs. 546 ± 4 μg/d, p < 0.0001), iron (16 ± 0.5 vs. 14 ± 0.1 mg/d, p = 0.01; 18 ± 0.9 vs. 16 ± 0.1 mg/d, p = 0.01), magnesium (249 ± 7 vs. 231 ± mg/d, p = 0.006; 327 ± 12 vs. 297 ± 2 mg/d, p < 0.02), and vitamin E as α-tocopherol (7 ± 0.4 vs. 6 ± 0.05 mg/d, p = 0.012; 10.0 ± 0.4 vs. 7.7 ± 0.1 mg/d, p < 0.0001), when compared to non-consumers of pasta, in children and adults, respectively. Daily intakes for potassium, calcium, vitamin A and vitamin D were similar when comparing pasta consumers to non-consumers of pasta. Adult pasta consumers had reduced added sugar and saturated fat intake, while no differences were observed for sodium intake vs. non-pasta consumption. Pasta consumption in children was associated with lower saturated fat, with no differences seen in added sugar and sodium intake. Pasta consumption was associated with an improved diet quality relative to non-pasta consumption (children: 48.6 ± 1.0 vs. 45.6 ± 0.2, p = 0.002; adult: 51.0 ± 0.9 vs. 48.9 ± 0.2, p = 0.024). No associations were observed when evaluating pasta consumption in all adults, however, gender-specific analysis revealed reduced body mass index, waist circumference, and body weight in females aged 19–50 years when compared to no pasta consumption. Overall, pasta consumption was associated with a better diet quality, improved nutrient intakes and lower intake of nutrients to limit relative to non-pasta consumption in Americans.

Fortified Foods Are Major Contributors to Apparent Intakes of Vitamin A and Iodine, but Not Iron, in Diets of Women of Reproductive Age in 4 African Countries

BACKGROUND

Food fortification is implemented to increase intakes of specific nutrients in the diet, but contributions of fortified foods to nutrient intakes are rarely quantified.

OBJECTIVES

We quantified iron, vitamin A, and iodine intakes from fortified staple foods and condiments among women of reproductive age (WRA).

METHODS

In subnational (Nigeria, South Africa) and national (Tanzania, Uganda) cross-sectional, clustered household surveys, we assessed fortifiable food consumption. We estimated daily nutrient intakes from fortified foods among WRA by multiplying the daily apparent fortifiable food consumption (by adult male equivalent method) by a fortification content for the food. Two fortification contents were used: measured, based on the median amount quantified from individual food samples collected from households; and potential, based on the targeted amount in national fortification standards. Results for both approaches are reported as percentages of the estimated average requirement (EAR) and recommended nutrient intake (RNI).

RESULTS

Fortified foods made modest contributions to measured iron intakes (0%-13% RNI); potential intakes if standards are met were generally higher (0%-65% RNI). Fortified foods contributed substantially to measured vitamin A and iodine intakes (20%-125% and 88%-253% EAR, respectively); potential intakes were higher (53%-655% and 115%-377% EAR, respectively) and would exceed the tolerable upper intake level among 18%-56% of WRA for vitamin A in Nigeria and 1%-8% of WRA for iodine in Nigeria, Tanzania, and Uganda.

CONCLUSIONS

Fortified foods are major contributors to apparent intakes of vitamin A and iodine, but not iron, among WRA. Contributions to vitamin A and iodine are observed despite fortification standards not consistently being met and, if constraints to meeting standards are addressed, there is risk of excessive intakes in some countries. For all programs assessed, nutrient intakes from all dietary sources and fortification standards should be reviewed to inform adjustments where needed to avoid risk of low or excessive intakes.

Healthy brain, healthy life: a review of diet and exercise interventions to promote brain health and reduce Alzheimer's disease risk

With the world's population aging at a rapid rate, the prevalence of Alzheimer's disease (AD) has significantly increased. These statistics are alarming given recent evidence that a third of dementia cases may be preventable. The role of lifestyle factors, such as diet and exercise, can directly alter the risk of disease development. However, an understanding of the effectiveness of dietary patterns and exercise strategies to reduce AD risk or improve brain function is not fully understood. The aim of this review is to discuss the effects of diet and exercise on AD risk. Key components of the Western and Mediterranean diets are discussed in relation to AD progression, as well as how physical activity promotes brain health. Components of the Western diet (saturated fatty acids and simple carbohydrates) are detrimental to the brain, impair cognition, and increase AD pathologies. While components of the Mediterranean diet (polyunsaturated fatty acids, polyphenols, and antioxidants) are considered to be neuroprotective. Exercise can significantly reduce the risk of AD; however, specific exercise recommendations for older adults are limited and optimal intensity, duration, and type remains unknown. This review highlights important modifiable risk factors for AD and points out potential avenues for future research. Novelty Diet and exercise are modifiable factors that can improve brain health and reduce the risk of AD. Polyunsaturated fatty acids, polyphenols, and antioxidants are neuroprotective. Exercise reduces neuroinflammation, improves brain insulin sensitivity, and increases brain derived neurotrophic factor.

Folate Nutritional Status among Psoriasis Patients not Exposed to Antifolate Drug

Background:

Folic acid fortification program has been established to prevent tube defects. However, concern has been raised among patients using anti-folate drug, i.e. psoriatic patients, a common, chronic, autoimmune inflammatory skin disease associated with obesity and smoking.

Objective:

To investigate dietary and circulating folate, vitamin B12 (B12) and homocysteine (hcy) in psoriatic subjects exposed to the national mandatory folic acid fortification program.

Methods:

Cross-sectional study using the Food Frequency Questionnaire, plasma folate, B12, hcy and psoriasis severity using the Psoriasis Area and Severity Index score. Median, interquartile ranges (IQRs) and linear regression models were conducted to investigate factors associated with plasma folate, B12 and hcy.

Results:

82 (73%) mild psoriasis, 18 (16%) moderate and 12 (11%) severe psoriasis. 58% female, 61% non-white, 31% former smokers, and 20% current smokers. Median (IQRs) were 51 (40, 60) years. Only 32% reached the Estimated Average Requirement of folate intake. Folate and B12 deficiencies were observed in 9% and 6% of the blood sample respectively, but hyperhomocysteinaemia in 21%. Severity of psoriasis was negatively correlated with folate and B12 concentrations. In a multiple linear regression model, folate intake contributed positively to 14% of serum folate, and negative predictors were psoriasis severity, smoking habits and saturated fatty acid explaining 29% of circulating folate.

Conclusion:

Only one third reached dietary intake of folate, but deficiencies of folate and B12 were low. Psoriasis severity was negatively correlated with circulating folate and B12. Stopping smoking and a folate rich diet may be important targets for managing psoriasis.

Relationship of added sugars intakes with physiologic parameters in adults: an analysis of national health and nutrition examination survey 2001-2012

INTRODUCTION

Consumption of added sugars (AS) has been associated with increased risk for liver disease and risk factors for cardiovascular disease. The objective of this study was to further understand the relationship of AS intake with liver enzymes and risk factors for cardiovascular disease in adults (n = 29,687) participating in the National Health and Nutrition Examination Survey (NHANES) 2001-2012.

METHODS

Individual usual intake (IUI) of AS was estimated using the Markov Chain Monte Carlo ratio method using two days of 24-hour dietary recalls gathered using standardized protocols. Subjects were separated into six consumption groups: 0 to <5%, 5 to <10%, 10 to <15%, 15 to <20%, 20 to <25% and ≥25% of energy as added sugars. Linear and group trends were determined using regression analyses for liver enzymes, cardiovascular risk factors, weight parameters, glucose, metabolic syndrome, and C-reactive protein. Logistic regression calculated odds ratios for these biomarkers above established risk levels (p < 0.01).

RESULTS

There was an inverse group trend association with AS IUI for lower body mass index (beta = -0.12 kg/m2 across AS intake groups); % overweight/obese or % obese also showed inverse group trend (-1.44, -0.77, % units across AS intake groups, respectively). Liver enzymes did not show a significant association with AS IUI. Mean plasma glucose levels (mg/dL) showed an inverse linear (beta = -0.13 mg/dL per AS intake); and group association with energy from AS IUI (beta = -0.71mg/d L across AS intake groups). There was no association of AS intake with the risk of elevated uric acid levels; however, the odds of reduced uric acid levels was 17% lower with increasing intake of energy from AS IUI in group trend analysis only (0.83; 0.72-0.95 [99th CI]).

CONCLUSION

Although it is sensible to consume AS in moderation, results suggested that higher intakes of AS were not consistently associated with physiologic parameters. Since the data were cross-sectional, they cannot be used to assess cause and effect. Thus, additional studies are warranted to confirm these findings with more rigorous study designs.

Contribution of Vitamin D2 and D3 and Their Respective 25-Hydroxy Metabolites to the Total Vitamin D Content of Beef and Lamb

BACKGROUND

Red meat and meat products can contribute meaningfully to the mean daily intake of vitamin D. Beef and lamb can contain vitamin D3 and 25-hydroxyvitamin D3 [25(OH)D3] but also potentially vitamin D2 and 25-hydroxyvitamin D2 [25(OH)D2], all of which contribute to meat's vitamin D activity.

OBJECTIVES

We aimed to measure the vitamin D3, vitamin D2, 25(OH)D3, and 25(OH)D2 content of Irish beef and lamb.

METHODS

Full striploin steaks (longissimus dorsi) (n = 39) from beef cattle slaughtered in winter, spring, summer, and autumn as well as lamb steaks (hind leg) from sheep slaughtered in autumn (n = 8) were sourced and homogenized. The contents of all 4 vitamin D-related compounds were analyzed using an LC-tandem MS method in conjunction with the National Institute of Standards and Technology's standard reference material no. 1546a-Meat Homogenate. The total vitamin D activity of meat was defined as: {vitamin D3 + [25(OH)D3 × 5] + vitamin D2 + [25(OH)D2 × 5]}.

RESULTS

The median (IQR) total vitamin D activity of striploin beef steak (n = 39, irrespective of season) was 0.56 (0.37-0.91) μg/100 g. The content of all 4 vitamin D compounds in beef steak varied significantly (P < 0.0001) with season (n = 8-11/season group). Median total vitamin D activity of beef steak increased in a stepwise manner (P < 0.0001) from winter to the following autumn (increasing from 0.31 to 1.07 μg/100 g). The mean total vitamin D activity of lamb samples (n = 8) from autumn was 0.47 μg/100 g.

CONCLUSIONS

About one-third of the total vitamin D activity of Irish beef was attributable to its combined vitamin D2 and 25(OH)D2 content, estimates of which are largely or completely missed in food composition tables. There was significant seasonal variation in all 4 vitamin D compounds as well as in total vitamin D activity, which has implications for vitamin D nutrient claims for beef.

Associations of Serum Retinol and α-Tocopherol Levels with Uric Acid Concentrations: Analysis of a Population-Based, Nationally Representative Sample

The effects of serum retinol and α-tocopherol on serum uric acid levels have not been established, especially in Asian people. This study evaluated the independent associations of retinol and α-tocopherol with serum uric acid levels in the Korean population. We included 6023 participants aged ≥ 19 years from the Korean National Health and Nutrition Examination Survey (KNHANES). Serum retinol and α-tocopherol levels were divided into quintiles, and a multivariate linear regression model was used to evaluate the association of serum retinol and α-tocopherol levels with uric acid concentration. Additionally, we used multivariate logistic regression to examine the relationships between the levels of these micronutrients and hyperuricemia. Serum retinol levels were positively associated with uric acid concentrations in a dose-dependent fashion in both sexes (p_trend < 0.001); the difference in serum uric acid levels between the highest and lowest quintiles of retinol levels was 0.57 mg/dL in men and 0.54 mg/dL in women. In the multivariable logistic model, the hyperuricemia risk increased linearly with the increase in serum retinol level, regardless of sex (p_trend < 0.001). Although the serum α-tocopherol level appeared to be significantly associated with increased uric acid levels, this association was nullified after adjusting for serum retinol levels. Serum retinol levels were positively associated with serum uric acid levels and hyperuricemia in a dose-response fashion. Maintaining serum retinol concentrations under sub-toxic levels might be necessary to prevent hyperuricemia-related adverse health outcomes.

Inadequacy of Immune Health Nutrients: Intakes in US Adults, the 2005-2016 NHANES

A well-functioning immune system is essential for human health and well-being. Micronutrients such as vitamins A, C, D, E, and zinc have several functions throughout the immune system, yet inadequate nutrient intakes are pervasive in the US population. A large body of research shows that nutrient inadequacies can impair immune function and weaken the immune response. Here, we present a new analysis of micronutrient usual intake estimates based on nationally representative data in 26,282 adults (>19 years) from the 2005-2016 National Health and Nutrition Examination Surveys (NHANES). Overall, the prevalence of inadequacy (% of population below estimated average requirement [EAR]) in four out of five key immune nutrients is substantial. Specifically, 45% of the U.S. population had a prevalence of inadequacy for vitamin A, 46% for vitamin C, 95% for vitamin D, 84% for vitamin E, and 15% for zinc. Dietary supplements can help address nutrient inadequacy for these immune-support nutrients, demonstrated by a lower prevalence of individuals below the EAR. Given the long-term presence and widening of nutrient gaps in the U.S.-specifically in critical nutrients that support immune health-public health measures should adopt guidelines to ensure an adequate intake of these micronutrients. Future research is needed to better understand the interactions and complexities of multiple nutrient shortfalls on immune health and assess and identify optimal levels of intake in at-risk populations.

Vitamin A Status and Deposition in Neonatal and Weanling Rats Reared by Mothers Consuming Normal and High-Fat Diets with Adequate or Supplemented Vitamin A

The circulating level of vitamin A (VA; retinol) was reported to be lower in obese adults. It is unknown if maternal obesity influences the VA status of offspring. The objective of the study was to determine the VA status and deposition of neonatal and weanling rats reared by mothers consuming a normal or high-fat diet (NFD or HFD) with or without supplemented VA. Pregnant Sprague-Dawley rats were randomized to an NFD or HFD with 2.6 mg/kg VA. Upon delivery, half of the rat mothers in the NFD or HFD cohort were switched to an NFD or HFD with supplemented VA at 129 mg/kg (NFD+VA and HFD+VA group). The other half remained on their original diet (NFD and HFD group). At postnatal day 14 (P14), P25, and P35, pups (n = 4 or 3/group/time) were euthanized. The total retinol concentration in the serum, liver, visceral white adipose tissue (WAT), and brown adipose tissue (BAT) was measured. At P14, the HFD+VA group showed a significantly lower serum VA than the NFD+VA group. At P25, both the VA concentration and total mass in the liver, WAT, and BAT were significantly higher in the HFD+VA than the NFD+VA group. At P35, the HFD group exhibited a significantly higher VA concentration and mass in the liver and BAT compared with the NFD group. In conclusion, maternal HFD consumption resulted in more VA accumulation in storage organs in neonatal and/or weanling rats, which potentially compromised the availability of VA in circulation, especially under the VA-supplemented condition.

Rising Trend of Hypokalemia Prevalence in the US Population and Possible Food Causes

Background: Potassium intake deficiency is a chronic issue in the US and many other countries. Possible causes of the deficiency are understudied.Objective: This study examined potassium deficiency in the US population and possible causes for the new trend.Methods: Serum potassium data of 28,379 men and 29,617 women between ages 12 and 80 years old who participated in the US National Health and Nutrition Examination Survey (NHANES) between 1999 and 2016 were examined. Blood samples were collected by NHANES and blood biochemistry data were measured in designed laboratories. The data were released bi-annually. Possible causes of low potassium intakes were explored.Results: There was an apparent decline of serum potassium in the US population between ages 12 and 80 years from 1999 to 2016. Annual average serum potassium concentrations changed from 4.14 ± 0.01 to 3.97 ± 0.01 mmol/l during this period. Hypokalemia prevalence in the US rose from 3.78%±0.68% to 11.06%±1.08% during this period with a higher hypokalemia prevalence in non-Hispanic black than in non-Hispanic white persons. It is possible that declining potassium concentration in food sources in the US contributed to lower potassium intake and increasing potassium deficiency.Conclusion: The rising trend of hypokalemia prevalence in the US population between 1999 and 2016 is alarming. Renewed efforts to reduce potassium intake deficiency in the US at population level are needed. The impact of possible decreasing crop available potassium levels and increasing consumption of processed food on the potassium deficit trend in the US are possible explanations for the rise in hypokalemia prevalence and require further study.

Synthetic α-Tocopherol, Compared with Natural α-Tocopherol, Downregulates Myelin Genes in Cerebella of Adolescent Ttpa-null Mice

BACKGROUND

Vitamin E (α-tocopherol; α-T) deficiency causes spinocerebellar ataxia. α-T supplementation improves neurological symptoms, but little is known about the differential bioactivities of natural versus synthetic α-T during early life.

OBJECTIVE

We assessed the effects of dietary α-T dose and source on tissue α-T accumulation and gene expression in adolescent α-tocopherol transfer protein-null (Ttpa-/-) mice.

METHODS

Three-week-old male Ttpa-/- mice (n  = 7/group) were fed 1 of 4 AIN-93G-based diets for 4 wk: vitamin E deficient (VED; below α-T limit of detection); natural α-T, 600 mg/kg diet (NAT); synthetic α-T, 816 mg/kg diet (SYN); or high synthetic α-T, 1200 mg/kg diet (HSYN). Male Ttpa+/+ littermates fed AIN-93G [75 mg synthetic α-T (CON)] served as controls (n  = 7). At 7 wk of age, tissue α-T concentrations and stereoisomer profiles were measured for all groups. RNA-sequencing was performed on cerebella of Ttpa-/- groups.

RESULTS

Ttpa-/- mice fed VED had undetectable brain α-T concentrations. Cerebral cortex α-T concentrations were greater in Ttpa-/- mice fed NAT (9.1 ± 0.7 nmol/g), SYN (10.8 ± 1.0 nmol/g), and HSYN (13.9 ± 1.6 nmol/g) compared with the VED group but were significantly lower than in Ttpa+/+ mice fed CON (24.6 ± 1.2 nmol/g) (P < 0.001). RRR-α-T was the predominant stereoisomer in brains of Ttpa+/+ mice (∼40%) and Ttpa-/- mice fed NAT (∼94%). α-T stereoisomer composition was similar in brains of Ttpa-/- mice fed SYN and HSYN (2R: ∼53%; 2S: ∼47%). Very few of the 16,774 genes measured were differentially expressed. However, compared with the NAT diet, HSYN significantly downregulated 20 myelin genes, including 2 transcription factors: SRY-box transcription factor 10 (Sox10) and myelin regulatory factor (Myrf), and several downstream target genes (false discovery rate <0.05).

CONCLUSIONS

High-dose synthetic α-T compared with natural α-T alters myelin gene expression in the adolescent mouse cerebellum, which could lead to morphological and functional abnormalities later in life.

Perspective: Whole and Refined Grains and Health-Evidence Supporting "Make Half Your Grains Whole"

Research-based dietary guidelines suggest that consumers "make half their grains whole." Yet some advocate ingesting only whole-grain foods (WGFs) and avoiding all refined-grain foods (RGFs). Some even recommend avoiding all grain-based foods (GBFs). This article will provide arguments to counter negative deductions about GBFs and RGFs, especially staple ones, and to support dietary guidance recommending a balance of GBFs-achieved through the right mix, type, and quantity of WGFs and RGFs. Studies looking at early mortality, body weight, and glucose tolerance and diabetes will be used as examples to characterize the literature about GBFs. The following issues are highlighted: 1) inconsistent findings between epidemiological and interventional studies and impacts of GBFs on health outcomes, and the underreporting of findings showing RGFs neither raise nor lower health risks; 2) multiple confounding and potential interactions make adequate statistical adjustment difficult; 3) nonuniform WGF definitions among studies make comparison of results challenging, especially because some WGFs may contain 49-74% refined grain (RG); 4) binary categorization of GBFs creates bias because nearly all categories of WGFs are recommended, but nearly half the RGF categories are not; 5) ingestion of >5 (30-g) servings RGFs/d and <1 serving WFGs/d creates dietary imbalance; 6) pattern names (e.g., "white bread") may impugn RGFs, when names such as "unbalanced" or "few fruits and vegetables" may more fairly characterize the dietary imbalance; 7) avoidance of all enriched RGs may not only impair status of folate and other B vitamins and certain minerals such as iron and zinc but also decrease acceptability of WGFs; 8) extrapolation beyond median documented intakes in high-WGF consumers (∼48 g whole grain/d) in most cohorts is speculative; 9) recommended dietary patterns such as the Mediterranean diet demonstrate that the right mix of WGFs and RGFs contributes to positive health outcomes.

Circulating Ionized Magnesium as a Measure of Supplement Bioavailability: Results from a Pilot Study for Randomized Clinical Trial

Oral supplementation may improve the dietary intake of magnesium, which has been identified as a shortfall nutrient. We conducted a pilot study to evaluate appropriate methods for assessing responses to the ingestion of oral magnesium supplements, including ionized magnesium in whole blood (iMg²⁺) concentration, serum total magnesium concentration, and total urinary magnesium content. In a single-blinded crossover study, 17 healthy adults were randomly assigned to consume 300 mg of magnesium from MgCl₂ (ReMag^®, a picosized magnesium formulation) or placebo, while having a low-magnesium breakfast. Blood and urine samples were obtained for the measurement of iMg²⁺, serum total magnesium, and total urine magnesium, during 24 h following the magnesium supplement or placebo dosing. Bioavailability was assessed using area-under-the-curve (AUC) as well as maximum (C_max) and time-to-maximum (T_max) concentration. Depending on normality, data were expressed as the mean ± standard deviation or median (range), and differences between responses to MgCl₂ or placebo were measured using the paired t-test or Wilcoxon signed-rank test. Following MgCl₂ administration versus placebo administration, we observed significantly greater increases in iMg²⁺ concentrations (AUC = 1.51 ± 0.96 vs. 0.84 ± 0.82 mg/dL•24h; C_max = 1.38 ± 0.13 vs. 1.32 ± 0.07 mg/dL, respectively; both p < 0.05) but not in serum total magnesium (AUC = 27.00 [0, 172.93] vs. 14.55 [0, 91.18] mg/dL•24h; C_max = 2.38 [1.97, 4.01] vs. 2.24 [1.98, 4.31] mg/dL) or in urinary magnesium (AUC = 201.74 ± 161.63 vs. 139.30 ± 92.84 mg•24h; C_max = 26.12 [12.91, 88.63] vs. 24.38 [13.51, 81.51] mg/dL; p > 0.05). Whole blood iMg²⁺ may be a more sensitive measure of acute oral intake of magnesium compared to serum and urinary magnesium and may be preferred for assessing supplement bioavailability.

Contribution of 100% Fruit Juice to Micronutrient Intakes in the United States, United Kingdom and Brazil

The contribution of 100% fruit juice (FJ) to the total daily intakes of energy, sugars, and select vitamins and minerals and to the recommended dietary allowances (RDAs) or adequate intake (AI) of these micronutrients was assessed in individuals reporting the consumption of 100% FJ in the national dietary intake surveys of the United States (U.S.; n = 8661), the United Kingdom (UK; n = 2546) and Brazil (n = 34,003). Associations of 100% FJ intake with the odds of being overweight or obese also were assessed. Data from the U.S. National Health and Nutrition Examination Survey (2013–2014), the UK National Diet and Nutrition Survey (2012–2014), and Brazil’s Pesquisa de Orçamentos Familiares (2008–2009) were used, and all analyses were limited to individuals reporting consumption of 100% FJ on at least one day of the dietary intake survey. Approximately 34%, 37%, and 42% of individuals surveyed reported the consumption of 100% FJ on at least one day of the dietary intake survey in the U.S., UK, and Brazil, respectively, and the average daily intakes of 100% FJ were 184 g, 130 g, and 249 g, respectively. Across the 3 countries, 100% FJ contributed to 3–6% of total energy intakes, 12–31% of total sugar intakes, 21–54% of total vitamin C intakes, 1–12% of total vitamin A intakes, 4–15% of total folate intakes, 7–17% of total potassium intakes, 2–7% of total calcium intakes, and 4–12% of total magnesium intakes. In a multivariate logistic regression model, juice intake was associated with a significant reduction in the odds of being overweight or obese in UK adults (OR = 0.79; 0.63, 0.99), and significant increases in the odds of being overweight or obese in UK children (OR = 1.16; 1.01, 1.33) and Brazilian adults (OR = 1.04; 1.00, 1.09). Nutrient contributions of 100% FJ vary according to regional intake levels. In all three countries studied, 100% FJ contributed to more than 5% of the RDAs for vitamin C and folate. In the U.S. and Brazil, 100% FJ contributed to more than 5% of the RDA for magnesium and more than 5% of the AI for potassium.

Regulatory and Policy-Related Aspects of Calcium Fortification of Foods. Implications for Implementing National Strategies of Calcium Fortification

Daily calcium intake is well below current recommendations in most low- and middle-income countries (LMICs). Calcium intake is usually related to bone health, however an adequate calcium intake has also been shown to reduce hypertensive disorders of pregnancy, lower blood pressure and cholesterol values, and to prevent recurrent colorectal adenomas. Fortification of foods has been identified as a cost-effective strategy to overcome micronutrient gaps in public health. This review summarizes regulatory aspects of fortification of commonly consumed foods with micronutrients, with an emphasis on calcium. We selected a convenient sample of 15 countries from different WHO regions and described the regulatory framework related to calcium fortification of staple foods. We assessed the relevant policies in electronic databases including the WHO Global database on the Implementation of Nutrition Action (GINA) for fortification policies and the Global Fortification Data Exchange Database, a fortification database developed and maintained by Food Fortification Initiative (FFI), Global Alliance for Improved Nutrition (GAIN), Iodine Global Network (IGN), and Micronutrient Forum. Food fortification with micronutrients is widely used in many of the selected countries. Most countries had national legislation for the addition of micronutrients to staple foods, especially wheat flour. These national legislations, that includes regulations and standards, can provide the framework to consider the implementation of adding calcium to the fortification strategies, including the selection of the adequate food vehicle to reach the targeted population at risk safely. The strategy to include calcium in the fortification mix in fortified staple foods seems promising in these countries. However, potential undesired changes on the organoleptic characteristics of fortified foods and products thereof, and operational feasibility at the manufacturing site should be evaluated by the stakeholders during the planning stage. Codex Alimentarius standards should be considered by regulators in order to assure adherence to international standards. While the selected countries already have established national regulations and/or standards for fortification of key staple food vehicles, and there are experiences in the implementation of fortification of some staple foods, national food intake surveys can help plan, design, and modify existing fortification programs as well as monitor food and nutrient consumption to assess risk and benefits.

Natural variation for carotenoids in fresh kernels is controlled by uncommon variants in sweet corn

Sweet corn (Zea mays L.) is highly consumed in the United States, but does not make major contributions to the daily intake of carotenoids (provitamin A carotenoids, lutein and zeaxanthin) that would help in the prevention of health complications. A genome-wide association study of seven kernel carotenoids and twelve derivative traits was conducted in a sweet corn inbred line association panel ranging from light to dark yellow in endosperm color to elucidate the genetic basis of carotenoid levels in fresh kernels. In agreement with earlier studies of maize kernels at maturity, we detected an association of β-carotene hydroxylase (crtRB1) with β-carotene concentration and lycopene epsilon cyclase (lcyE) with the ratio of flux between the α- and β-carotene branches in the carotenoid biosynthetic pathway. Additionally, we found that 5% or less of the evaluated inbred lines possessing the shrunken2 (sh2) endosperm mutation had the most favorable lycE allele or crtRB1 haplotype for elevating β-branch carotenoids (β-carotene and zeaxanthin) or β-carotene, respectively. Genomic prediction models with genome-wide markers obtained moderately high predictive abilities for the carotenoid traits, especially lutein, and outperformed models with less markers that targeted candidate genes implicated in the synthesis, retention, and/or genetic control of kernel carotenoids. Taken together, our results constitute an important step toward increasing carotenoids in fresh sweet corn kernels.

Ready-to-eat cereal fortification: a modelling study on the impact of changing ready-to-eat cereal fortification levels on population intake of nutrients

OBJECTIVE

Ready-to-eat (RTE) cereal is an important source of nutrients in the American diet. Recent regulatory changes to labelling requirements may impact the fortification of RTE cereal. We used an evidence-based approach to optimize the fortification of RTE cereal considering current dietary patterns and nutrition policy.

DESIGN

A US modelling study of cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. The percentage of the population below the Estimated Average Requirement (EAR) and above the Upper Tolerable Intake Level (UL) was modelled under three scenarios: baseline, zero fortification and optimized fortification.

SETTING

USA.

PARTICIPANTS

Toddlers aged 1-3 years, n 559; children aged 4-12 years, n 1540; adolescents aged 13-18 years, n 992; and adults aged ≥19 years, n 576.

RESULTS

Comparing current with optimized fortification, nutrient/100 g RTE cereal decreased for vitamin A, thiamin, riboflavin, niacin, vitamin B6, folic acid, vitamin B12, Ca and Fe (by 2-82 %). The amount of vitamins C and D increased (by 13 and 50 %, respectively). Among RTE cereal eaters, these changes resulted in modest increases in the percentage of the population aged ≥1 year below the EAR (+0·5 to +11·5 percentage points). Decreases were observed in the percentage of the population above the UL.

CONCLUSIONS

Fortification of RTE cereal can be optimized to provide key nutrients and minimize the percentage of the population below the EAR and above the UL. Dietary intake modelling is useful to ensure that RTE cereal continues to help the population meet their nutrient needs.

Modeling Possible Outcomes of Updated Daily Values on Nutrient Intakes of the United States Adult Population

The United States (US) Food and Drug Administration has updated the Daily Values (DVs) for the Nutrition Facts Label on packaged foods. We used the National Health and Nutrition Examination Survey 2009-2012 data with the International Life Sciences Institute, North America Fortification Database, which identifies intrinsic, mandatory enriched, and fortified sources of nutrients in foods and beverages, to model the new DVs' potential impact on adult (≥19 years of age) intake. We assumed that manufacturers will adjust voluntary fortification to maintain percent DV claims. We assessed the percent of the US population whose usual intake (UI) was < the Estimated Average Requirement (EAR), and ≥ the Upper Limit (UL) based on the current DVs, and modeled estimated UI and % Collapse

Key Words

• Daily Values (DV)
• Estimated Average Requirement (EAR)
• National Health and Nutrition Examination Survey (NHANES)
• Nutrition Facts Label
• Upper Limit (UL)
• adults
• fortification
• usual intake (UI)

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MESH Headings

• Adult
• Aged
• Diet
• Female
• Food Labeling
• Humans
• Male
• Micronutrients/analysis
• Middle Aged
• Models, Statistical
• Nutrition Surveys
• Nutritional Requirements/physiology
• Nutritional Status/physiology
• United States
• Vitamin A/analysis
• Vitamins/analysis
• Young Adult

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Grants

• funds to the Medical University of South Carolina International Life Sciences Institute North America

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Affiliation(s)

Jill C. Newman Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA;
Michael I. McBurney Human Health & Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada;
Kelly J. Hunt Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (K.J.H.); (A.M.M.)
Angela M. Malek Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (K.J.H.); (A.M.M.)
Bernadette P. Marriott Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA

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Evidence Supporting a Phased Immuno-physiological Approach to COVID-19 From Prevention Through Recovery

This paper presents an evidence-based strategy for improving clinical outcomes in COVID-19. Recommendations are based on the phases of the disease, because optimal interventions for one phase may not be appropriate for a different phase. The four phases addressed are: Prevention, Infection, Inflammation and Recovery. Underlying this phased approach is recognition of emerging evidence for two different components of pathophysiology, early infection and late stage severe complications. These two aspects of the disease suggest two different patterns of clinical emphasis that seem on the surface to be not entirely concordant. We describe the application of therapeutic strategies and appropriate tactics that address four main stages of disease progression for COVID-19. Emerging evidence in COVID-19 suggests that the SARS-CoV-2 virus may both evade the innate immune response and kill macrophages. Delayed innate immune response and a depleted population of macrophages can theoretically result in a blunted antigen presentation, delaying and diminishing activation of the adaptive immune response. Thus, one clinical strategy involves supporting patient innate and adaptive immune responses early in the time course of illness, with the goal of improving the timeliness, readiness, and robustness of both the innate and adaptive immune responses. At the other end of the disease pathology spectrum, risk of fatality in COVID-19 is driven by excessive and persistent upregulation of inflammatory mechanisms associated with cytokine storm. Thus, the second clinical strategy is to prevent or mitigate excessive inflammatory response to prevent the cytokine storm associated with high mortality risk. Clinical support for immune system pathogen clearance mechanisms involves obligate activation of immune response components that are inherently inflammatory. This puts the goals of the first clinical strategy (immune activation) potentially at odds with the goals of the second strategy(mitigation of proinflammatory effects). This creates a need for discernment about the time course of the illness and with that, understanding of which components of an overall strategy to apply at each phase of the time course of the illness. We review evidence from early observational studies and the existing literature on both outcomes and mechanisms of disease, to inform a phased approach to support the patient at risk for infection, with infection, with escalating inflammation during infection, and at risk of negative sequelae as they move into recovery.

Vitamin D Deficiency: Defining, Prevalence, Causes, and Strategies of Addressing

There are variable definitions of vitamin D deficiency, based on different thresholds of serum 25-hydroxyvitamin D (25(OH)D); this has a major bearing on the prevalence estimates of vitamin D deficiency and consequently on the magnitude of the public health issue of low vitamin D status. Despite this, there is widespread acknowledgement of the presence of vitamin D deficiency, even using the most conservative serum 25(OH)D threshold of < 25/30 nmol/L, in both low- and high-income country setting and the pressing need to address this deficiency. While ultraviolet B-rich sunlight stimulates synthesis of vitamin D in skin, there are environmental factors and personal characteristics which prevent or impede such dermal synthesis. There are several complexities and concerns in advocating sun exposure as a public health approach for increasing vitamin D status. This places increased emphasis on addressing vitamin D deficiency through dietary means. However, naturally rich sources of vitamin D are few and infrequently consumed, and nutrition surveillance data from various countries have indicated that habitual vitamin D intakes in the population are much lower than the recommendations. There are a number of strategies that can be considered for the control of micronutrient malnutrition, these include (i) increasing the diversity of foods consumed, (ii) food fortification, and (iii) supplementation. The present narrative review will consider these strategies for addressing low dietary vitamin D intake and consequently lowering the risk of vitamin D deficiency.

Food Sources of Shortfall Nutrients Among US Adolescents: National Health and Nutrition Examination Survey (NHANES) 2011-2014

To identify food sources of shortfall nutrients consumed by adolescents (n = 3156), data from the National Health and Nutrition Examination Survey (NHANES) (2011-2014) were used. Some of the food groups commonly consumed by adolescents made a significant contribution to shortfall nutrient intakes in the diet. Many food sources that provided significant amounts of shortfall nutrients were from foods that also provided nutrients to limit. Awareness of nutrient intakes and food sources is essential to establish dietary guidance in a practical context. Efforts to continue monitoring the food sources of nutrients consumed by adolescents will be important to improve the current knowledge on this topic of research.

AhR and IDO1 in pathogenesis of Covid-19 and the "Systemic AhR Activation Syndrome:" a translational review and therapeutic perspectives

Covid-19 is the acute illness caused by SARS-CoV-2 with initial clinical symptoms such as cough, fever, malaise, headache, and anosmia. After entry into cells, corona viruses (CoV) activate aryl hydrocarbon receptors (AhRs) by an indoleamine 2,3-dioxygenase (IDO1)-independent mechanism, bypassing the IDO1-kynurenine-AhR pathway. The IDO1-kynurenine-AhR signaling pathway is used by multiple viral, microbial and parasitic pathogens to activate AhRs and to establish infections. AhRs enhance their own activity through an IDO1-AhR-IDO1 positive feedback loop prolonging activation induced by pathogens. Direct activation of AhRs by CoV induces immediate and simultaneous up-regulation of diverse AhR-dependent downstream effectors, and this, in turn, results in a "Systemic AhR Activation Syndrome" (SAAS) consisting of inflammation, thromboembolism, and fibrosis, culminating in multiple organ injuries, and death. Activation of AhRs by CoV may lead to diverse sets of phenotypic disease pictures depending on time after infection, overall state of health, hormonal balance, age, gender, comorbidities, but also diet and environmental factors modulating AhRs. We hypothesize that elimination of factors known to up-regulate AhRs, or implementation of measures known to down-regulate AhRs, should decrease severity of infection. Although therapies selectively down-regulating both AhR and IDO1 are currently lacking, medications in clinical use such as dexamethasone may down-regulate both AhR and IDO1 genes, as calcitriol/vitamin D3 may down-regulate the AhR gene, and tocopherol/vitamin E may down-regulate the IDO1 gene. Supplementation of calcitriol should therefore be subjected to epidemiological studies and tested in prospective trials for prevention of CoV infections, as should tocopherol, whereas dexamethasone could be tried in interventional trials. Because lack of physical exercise activates AhRs via the IDO1-kynurenine-AhR signaling pathway increasing risk of infection, physical exercise should be encouraged during quarantines and stay-at-home orders during pandemic outbreaks. Understanding which factors affect gene expression of both AhR and IDO1 may help in designing therapies to prevent and treat humans suffering from Covid-19.

Diet Quality and Micronutrient Intake among Long-Term Weight Loss Maintainers

Inadequate vitamin and mineral intake is documented among individuals with obesity, but is unknown among long-term weight loss maintainers (WLM). This study examined dietary quality and micronutrient adequacy among WLMs in a commercial weight management program. Participants were 1207 WLM in Weight Watchers (WW) who had maintained a 9.1 kg or greater weight loss (29.7 kg on average) for 3.4 years and had a body mass index (BMI) of 28.3 kg/m². A control group of weight stable adults with obesity (controls; N = 102) had a BMI of 41.1 kg/m². Measures included the Diet History Questionnaire-II, Healthy Eating Index-2015 (HEI), and Dietary References Intakes. WLM versus controls had a 10.1 point higher HEI score (70.2 (69.7–70.7) vs. 60.1 (58.4–61.8); p = 0.0001) and greater odds of meeting recommendations for copper (OR = 5.8 (2.6–13.1)), magnesium (OR = 2.9 (1.8–4.7)), potassium (OR = 4.7 (1.4–16.5)), vitamin A (OR = 2.8 (1.7–4.8)), vitamin B6 (OR = 2.9 (1.6–5.2)), and vitamin C (OR = 5.0 (2.8–8.8)). WLM, compared to controls, also reported higher percentages of calories from carbohydrates (50.3% (49.7–50.8) vs. 46.7% (44.8–48.7); p = 0.0001) and protein (18.2% (18.0–18.5) vs. 15.9% (15.1–16.6); p = 0.0001) and lower calories from fat (32.3% (31.9–32.8) vs. 37.4% (35.8–38.9); p = 0.0001). Long-term weight loss maintenance in a widely used commercial program was associated with a healthier diet pattern, including consuming foods with higher micronutrient density.

Single-Cell RNA-seq Reveals Profound Alterations in Mechanosensitive Dorsal Root Ganglion Neurons with Vitamin E Deficiency

Ninety percent of Americans consume less than the estimated average requirements of dietary vitamin E (vitE). Severe vitE deficiency due to genetic mutations in the tocopherol transfer protein (TTPA) in humans results in ataxia with vitE deficiency (AVED), with proprioceptive deficits and somatosensory degeneration arising from dorsal root ganglia neurons (DRGNs). Single-cell RNA-sequencing of DRGNs was performed in Ttpa-/- mice, an established model of AVED. In stark contrast to expected changes in proprioceptive neurons, Ttpa-/- DRGNs showed marked upregulation of voltage-gated Ca2+ and K+ channels in mechanosensitive, tyrosine-hydroxylase positive (TH+) DRGNs. The ensuing significant conductance changes resulted in reduced excitability in mechanosensitive Ttpa-/- DRGNs. A highly supplemented vitE diet (600 mg dl-α-tocopheryl acetate/kg diet) prevented the cellular and molecular alterations and improved mechanosensation. VitE deficiency profoundly alters the molecular signature and functional properties of mechanosensitive TH+ DRGN, representing an intriguing shift of the prevailing paradigm from proprioception to mechanical sensation.