Scientific Opinion on Dietary Reference Values for calcium

The Diagnosis and Therapy of XLH

X-linked hypophosphatemia is a rare genetic disease caused by pathogenic variants in the PHEX (phosphate-regulating endopeptidase homolog X-linked) gene with X-linked dominant inheritance that causes metabolic bone disease and other severe complications. PHEX dysfunction results in increased production and secretion of the phosphaturic hormone fibroblast growth factor 23 (FGF23) from bone. The consequences of FGF23 excess are renal phosphate wasting and decreased calcitriol synthesis, leading to hypophosphatemia and subsequently rickets and osteomalacia. Children with XLH usually become symptomatic in the second year of life presenting with progressive disproportionate short stature, bone pain, frontal bossing, enlarged joints, bowed legs, and a waddling gait. Various other symptoms may develop later, including dental abscesses, peritonitis, hearing loss, pseudofractures, spinal stenosis, osteoarthritis, and enthesopathies, often leading to a diminished quality of life and ultimately disability. Here, we provide an overview of the current knowledge of the pathophysiology and treatment insights of this rare and challenging disease, including the targeting of FGF23 as a therapeutic approach that has significantly improved patient outcomes.

Nutrient and Phytochemical Composition of Nine African Leafy Vegetables: A Comparative Study

Micronutrient deficiencies and the increased incidences of non-communicable diseases are public health challenges for the sub-Saharan population. Leafy vegetables reportedly contain several minerals, vitamins and antioxidant compounds which could help reduce the above challenges. However, overall vegetable consumption is still low in Uganda, partly due to limited information about the nutritional quality and health-promoting properties of the available vegetable species. To provide scientific justification for increased growth/production and utilisation of specific leafy vegetable species as food, the nutrient and phytochemical compositions were determined in nine African leafy vegetables. The 'true' protein and dietary fibre contents were 13-33 and 29-43 g/100 g DW, respectively, whereas the starch content was below 6 g/100 g DW. As for the minerals, the Ca, Mg, and Fe contents were 630-3395, 324-1428, and 14-78 mg/100 g DW, respectively, whereas the Zn content was below 6 mg/100 g DW. High carotenoid contents were observed with lutein and β-carotene as the predominant carotenoids (25-60 and 12-29 mg/100 g DW, respectively). The vitamin C and total polyphenol contents were 24-253 mg/100 g DW and 17-43 mg GAE/g DW, respectively. The leafy vegetables studied are low-calorie and can be considered alternative protein sources. They are generally health-beneficial foods as they contain natural antioxidant compounds, vitamin C, carotenoids and polyphenols. African nightshade, Amaranthus sp., cowpea leaves, and spider plant are potential sources of provitamin A (β-carotene) and minerals (Ca and Fe); hence, they can help reduce incidences of related deficiencies.

Micro-nutrient sufficiency in mothers and babies: management of deficiencies while avoiding overload during pregnancy

Pregnancy is a period characterized by extensive physiological changes in both the mother and fetus. During this period, the nutritional status of the mother has a profound and irreversible impact on her health and the growth and development of the fetus. The fetus depends exclusively on the mother and drives nutrients through the placenta. Therefore, mothers must be provided with a well-balanced diet that is adequate in both macro- and micronutrients. Most pregnant women generally manage to get adequate macronutrients; however, many women fail to get micronutrients up to the recommended dietary allowance. Micronutrients such as vitamins and minerals are necessary for preventing congenital abnormalities and the optimal development of the brain and body of the fetus. Their inadequacy can lead to complications like anemia, hypertension, pre-eclampsia, maternal and fetal hypothyroidism, premature infants, intrauterine growth restriction, stillbirth, and other negative pregnancy outcomes. New studies recommend the use of prenatal micronutrient supplements to prevent birth defects and health issues caused by deficiencies in folic acid, iron, iodine, and calcium during pregnancy. This is especially important in developing nations where deficiencies are prevalent. Also while using these supplements, their upper limits (UL) must be considered to avoid overload. In this review, we provide an overview of the four most critical micronutrients during pregnancy: iron, folic acid, iodine, and calcium. We provide insight into their sources, RDAs, deficiency consequences, and the need for supplementation while considering the risk of micronutrient overload. To maximize the potential benefits while minimizing the risk of nutrient overload, although knowledge gaps remain.

Bioactive Compounds, Antioxidant, and Antimicrobial Activity of Seeds and Mucilage of Non-Traditional Cocoas

The biodiversity of the Amazon rainforest includes little-known cocoa species, which are essential resources for local communities. This study evaluated the bioactive compounds and antioxidant and antimicrobial activity of seeds and mucilage of four non-traditional cocoa species (Theobroma subincanum, T. speciosum, T. bicolor and Herrania nitida). Physico-chemical properties, minerals, vitamin C, organic acids, phenolics, and carotenoids were analysed by spectrophotometric and chromatographic techniques. The antioxidant activity was measured by ABTS and DPPH, along with the antimicrobial activity against Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Streptococcus mutans, as well as Candida albicans and Candida tropicalis. T. subincanum seeds scored high in titratable acidity, magnesium, sodium, syringic acid, chlorogenic acid, caffeic acid, rutin, and quercetin. In contrast, the mucilage scored high in calcium, m-coumaric acid, ferulic acid, kaempferol, quercetin glycoside, and antimicrobial activity against Streptococcus mutans. T. speciosum mucilage excelled in malic acid, tartaric acid, naringenin, and antioxidant capacity. T. bicolor seeds excelled in lutein and antimicrobial activity against Staphylococcus aureus and Candida albicans, and mucilage in iron, potassium, vitamin C, citric acid, gallic acid and 4-hydroxybenzoic acid, zeaxanthin, β-carotene, and antioxidant capacity by ABTS. The mucilage of H. nitida has a high soluble solids content. These results highlight the potential of these species as sustainable sources of functional compounds and nutraceuticals.

Prospective Study of Urinary Stone Formation in Pediatric Patients with Acquired Brain Injury: A Focus on Incidence and Analysis of Risk Factors

Background/Objectives: Little is known about the factors linked with nutrition, infections, and physical activity, which may influence urinary stone formation in patients with acquired brain injury. Previous studies have demonstrated that enteral nutrition mixtures rich in sodium and poor in calcium may promote stone formation in pediatric patients, but a confirmation study is lacking. Moreover, the occurrence of urinary stones and heterotopic ossifications has not been studied regarding incidence. We thus conducted a prospective observational study in an unselected pediatric population with acquired brain injury, to estimate the incidence of urinary stones and heterotopic ossifications and analyze the associated factors. Methods: Prospective observational study: We recruited all patients with enteral nutrition consecutively admitted to our brain injury rehabilitation unit during a 5-year time-frame. We collected clinical data regarding nutrition, infections, blood and urine exams performed, neurological examinations, and physical examinations. Results: The prospective design allowed us to observe that no patient developed heterotopic ossifications, while urinary stones were found in 12.5% of patients and gravel in 14.6%. Factors associated with stone formation were having a worse subacute GCS, having done intense physical activity before injury, receiving bladder catheterizations, having a higher urine pH, and having higher blood potassium levels. The composition of the enteral nutrition did not influence stone formation, although the nutrition mixtures contained levels of vitamin C and proteins considerably higher than the recommended reference ranges. Conclusions: We have provided an observation of the incidence of urolithiasis in pediatric patients in rehabilitation, which was lacking from the literature. Enteral nutrition, at the amounts received by the patients studied herein, does not seem to have a role in stone formation. We identified a set of risk factors that can be useful for clinicians to pinpoint patients at an increased risk of developing stones.

Elemental and Radiological Characterisation of Arbutus unedo L. Leaves and Tea: Impact of Preparation Method on Nutritional Risk/Benefit

The aim of this study was to characterise the elemental and radiological composition of strawberry tree (Arbutus unedo L.) leaves and tea preparations and compare it with commercial Uvin H herbal mixture, widely used in treatment of urinary tract infections. The concentration of 17 elements and the activity concentration of selected radionuclides were measured in strawberry tree leaves/Uvin H herbal mixture, as well as in herbal tea prepared by infusion or decoction of leaves for 5 or 10 min. In both leaves and tea preparations, Ca, K, Mg, and Na were the most abundant elements, while the lowest levels were measured for As, Co, Mo, and Se. Only 137Cs and 40K were detected in analysed leaves/herbal mixture, while the activity of radionuclides in tea preparations was below the detection limit. The maximum possible health benefits can be obtained by a 10-min decoction of leaves, which resulted in the highest total phenolic content and antioxidant activity and levels of K, Ca, Mg, Na, Fe, Mn, and Se in comparison to the other preparation methods evaluated in this study. The calculated intake of potentially toxic elements and radionuclides does not represent a health risk to consumers.

Vegetarian Diets During Complementary Feeding: An Overview of Nutritional and Health Features

Nowadays, vegetarian diets are present in a solid way in Western countries' lifestyles. Some families opt for this dietetic pattern for their infants too, during the period of introduction of complementary foods. Many releases have been issued about this subject, with different and often contradictory advice and conclusions. The aim of this work is to provide a comprehensive overview through the analysis of recently published opinions of the implementation of a vegetarian or vegan diet over the course of complementary feeding. The literature agrees about some key points to consider, that is the necessity for the diet to be well-planned, in order to meet energy, macro- and micronutrients requirements, as well as the need to follow the child longitudinally. Also, there is a substantial agreement on the need for fortified foods and/or supplements to be included in the diet. Following these suggestions, most (but not all) of the papers agree that normal growth and development may be achieved. Final considerations, however, are not straightforward to make and more research with better definition of the features of the diet adopted and of supplementation used and long-term follow-up studies are highly warranted.

Evaluation of the Nutritional Impact of Baobab Leaves (Adansonia digitata L.) as a Dietary Intervention to Combat Nutrient Deficiencies and Poverty-Related Health Problems

BACKGROUND/OBJECTIVES

Baobab (Adansonia digitate L.) is an underutilized species and edible parts (fruits, leaves and seeds) contribute to food security and human health in tropical areas. Although the fruits have attracted greater research interest and have recently been approved for consumption in EU countries, the leaves are traditionally consumed but they have yet to be studied from an interventional perspective. The aim of this study was to propose a protocol for a dietary intervention using baobab leaves (BLs) to achieve the recommended reference values for proteins and minerals (K, Ca, Mg, Na, Fe, Mn) for different target groups of the Sudanese population.

METHODS

Dry matter, crude fat, protein and ash content, mineral content (Na, Mg, K, Ca, Fe, Mn), total phenolic, and flavonoid compounds were determined in BLs from six different areas. To assess the health and nutrition status in Sudan, time-series data (2013-2023) from the DataBank Health Nutrition and Population Statistics database were used. The reference values for nutrients recommended by the European Food Safety Authority were used to estimate the amount of baobab leaf intake (BLI, g/day).

RESULTS

For each nutrient, the study area with the lowest amount of BLs to be consumed is recommended. Leaves from the area of El Gari (BN3) 18.312 g/day and 30.712 g/day are recommended for K and Ca, which are particularly beneficial for children aged 1-3 years and lactating women. Leaves from Kor Tagat (KR1) are suitable for sodium intake, requiring approximately 13-23 g/day across all age groups. Leaves from Kazgil (KR2) (46-81 g/day), (35-66 g/day), (0.48-0.68 g/day), and (4-6 g/day) are optimal for fulfilling the daily requirements of magnesium, iron, manganese, and protein in this order.

CONCLUSIONS

The systematic inclusion of BLs in the diet can positively support the nutritional status of various demographics. Moreover, the findings of this study demonstrated the foundation for public health and nutritional policy-makers on how they will tackle malnutrition and food insecurity worldwide by incorporating naturally available diets and nutritious alternatives.

RECOMMENDATION

Further research should focus on assessing the nutritional composition factors that could affect the absorption of nutrients such as phytates and oxalates and investigating the in vitro bioavailability of the elements.

Planetary Health Diet for Childhood Obesity Prevention: Integrating Nutritional Health with Environmental Stewardship

BACKGROUND

Childhood obesity is a critical public health challenge with a rising prevalence worldwide, contributing to numerous health risks and long-term societal burdens. Concurrently, climate change and environmental degradation demand sustainable approaches to dietary patterns. The Planetary Health Diet (PHD), initially designed for adults, emphasizes plant-based foods and sustainable practices.

OBJECTIVES

This review explores the suitability of the PHD for addressing childhood obesity by assessing its nutritional adequacy and proposing necessary adaptations for pediatric populations.

METHODS

A narrative review methodology was employed, examining data from global and regional nutritional guidelines and evaluating the PHD's bromatological composition against age-specific requirements.

RESULTS

The findings indicate that while the PHD aligns with environmental goals, it may not fully meet the energy and specific nutrient needs of children and adolescents without modifications. Key challenges include ensuring adequate intake of bioavailable protein, iron, calcium, vitamin B12, and vitamin D. Strategies such as incorporating fortified foods, optimizing food pairings, and gradual adaptation to high-fiber diets are critical for successful implementation. This review also highlights the importance of cultural adaptability, family involvement, and regional food systems in promoting adherence. Tailored interventions, such as school meal programs and educational initiatives, can bridge gaps in nutrition while fostering sustainable dietary behaviors.

CONCLUSIONS

Adapting the PHD for pediatric needs presents an opportunity to integrate nutritional health with environmental stewardship, contributing to obesity prevention and a sustainable future. Further research is required to validate these adaptations and develop comprehensive frameworks for global implementation.

Day-to-Day Fluctuation in Micronutrient Content in Human Milk Relative to Maternal Diet

BACKGROUND/OBJECTIVES

The impact of daily variations in habitual maternal intake on human milk (HM) composition has been poorly studied. We aimed to investigate the associations between day-to-day fluctuation in the micronutrient concentration in HM and daily maternal diet.

METHODS

To this end, an observational longitudinal study was carried out. A total of 143 lactating women each compiled a five-day weighed dietary record and concomitantly expressed milk for four successive days. Maternal daily intakes of micronutrients and food groups were analyzed. Free thiamine, free riboflavin, nicotinamide, pantothenic acid, pyridoxal, folic acid, cobalamin, ascorbic and dehydroascorbic acids, retinol, alpha- and gamma-tocopherol, cholecalciferol, and calcidiol in HM were determined for each of the four investigated days. A longitudinal data analysis with generalized estimating equation models was performed.

RESULTS

For each daily serving of meat, fish, and eggs, total vitamin D3 levels increased by 243.2 pg/mL (p = 0.027) and selenium levels increased by 0.16 ppb (p = 0.031) in HM. For every 1 mg/day of riboflavin supplementation, free riboflavin levels in HM increased by 28.6 mcg/L (p = 0.019). Pyridoxal levels in HM increased by 6.3 mcg/L per 1 mg/day of vitamin B6 supplementation (p = 0.001), and by 2 mcg/L per daily fruit ration (p = 0.016).

CONCLUSIONS

In conclusion, we were able to quantify the impact of the usual day-to-day variations in the diet and in the intake of commonly used supplements on the fluctuation of vitamin D, free riboflavin, pyridoxal, and selenium concentration in the milk of lactating women.

Association between calcium intake from different food sources during childhood and cardiometabolic risk on adolescence: The Generation XXI birth cohort

BACKGROUND

Calcium intake has been associated with lower adiposity, but few studies explored the longitudinal relation of calcium from different sources and cardiometabolic markers in young population.

OBJECTIVE

Prospectively estimate the association between dairy and non-dairy calcium intake at 4, 7, and 10 years (y) of age and cardiometabolic risk at 13 y.

METHODS

The sample included 4017 participants from the Generation XXI birth cohort. Dietary data were collected from a 3-day food diary. Cardiometabolic clusters at 13 y were estimated by a probabilistic Gaussian mixture model (z-score of waist circumference [WC], HOMA-IR; HDL cholesterol, triglycerides, and systolic blood pressure [BP]). Multivariable linear and logistic regression models were used to estimate associations.

RESULTS

Calcium intake (/100 mg), after adjustment for confounders, was negatively and significantly associated with body mass index (BMI) (β = -0.02, 95% CI: -0.04; -0.01), WC (cm) (β = -0.23, 95% CI: -0.36; -0.11), and diastolic BP (mmHg) (β = -0.14, 95% CI: -0.26; -0.03). After additional adjustment for total energy intake, associations lose statistical significance. Calcium intake from milk at 7 y was inversely associated with WC (β = -0.25, 95% CI: -0.48; -0.03) and from yogurt at 10 y was associated with higher BMI (β = 0.08, 95% CI: 0.03; 0.13) and WC (β = 0.54, 95% CI: 0.12; 0.96). Calcium from vegetables at 4, 7, 10 y reduces later cardiometabolic risk (OR = 0.71; OR = 0.84; OR = 0.98, respectively).

CONCLUSIONS

This study supports a protective effect of calcium on adolescents' cardiometabolic health, especially from vegetables.

Iron Deficiency Is Associated with Elevated Parathormone Levels, Low Vitamin D Status, and Risk of Bone Loss in Omnivores and Plant-Based Diet Consumers

A cross-sectional study was performed in healthy adults (mean age 28 y, 67% women) whose habitual diet was an omnivore, lacto-ovo vegetarian, or vegan diet. The total sample (n = 297) was divided into two groups according to the parathormone (PTH) cut-off value of 65 pg/mL of either normal-PTH (n = 228) or high-PTH (n = 69). Vitamin D status (25-hydroxycholecalciferol, 25-OHD), PTH, and bone formation (bone alkaline phosphatase, BAP) and bone resorption (N-telopeptides of type I collagen, NTx) markers were determined. Hematocrit, erythrocytes, hemoglobin, platelets, serum iron, serum transferrin, transferrin saturation, and serum ferritin were also measured. In the total sample, 25-OHD and PTH were negatively correlated, and all subjects with high PTH presented vitamin D insufficiency (25-OHD < 75 nmol/L). High bone remodeling was observed in the high-PTH group, with significantly higher NTx and marginally higher BAP compared to the normal-PTH group. Hematocrit and ferritin were significantly lower in the high-PTH compared to the normal-PTH group. However, serum iron was higher in the high-PTH group, which was only observed for the lacto-ovo vegetarian and vegan subjects. It is concluded that both low vitamin D and low iron status are associated with elevated PTH and bone resorption, more in vegetarians than omnivores, which is in line with the hypothesis that chronic iron deficiency in adulthood mainly predisposes to osteoporosis in postmenopausal women and the elderly.

A Landscape of Micronutrient Dietary Intake by 15- to 65-Years-Old Urban Population in 8 Latin American Countries: Results From the Latin American Study of Health and Nutrition

BACKGROUND

Latin American countries have shifted from traditional diets rich in micronutrients to a Westernized diet rich in high energy-dense foods and low in micronutrients.

OBJECTIVE

This study aimed to determine the prevalence of adequate micronutrient intakes in urban populations of 8 Latin American countries.

METHOD

Micronutrient dietary intake data were collected from September 2014 to August 2015 from 9216 men and women aged 15.0 to 65.0 years living in urban populations of 8 Latin American countries. Dietary intake was collected using two 24-hour recalls on nonconsecutive days. Micronutrient adequacy of intake was calculated using the Estimated Average Requirement cut-off method.

RESULTS

In general terms, the prevalence of inadequate intake of thiamine, riboflavin, niacin, folate, cobalamin, iron, phosphorus, copper, and selenium ranged from 0.4% to 9.9%. In contrast, the prevalence of inadequacy of pyridoxine, zinc, vitamin C, and vitamin A ranged from 15.7% to 51.5%. The nutrients with a critical prevalence of inadequacy were magnesium (80.5%), calcium (85.7%), and vitamin D (98.2%). The highest prevalence of inadequate intakes was observed in the low educational level, participants with overweight/obesity, in men, and varies according to socioeconomic status.

CONCLUSIONS

There is an urgent need to define direct regional actions and strategies in Latin America aimed at improving micronutrient adequacy, either through staple food fortification programs, agronomic biofortification, or food policies that facilitate economic access to micronutrient-rich foods.

Dietary content and combined training, but not daily physical activity, are associated with 6-month bone mineral changes in adolescents with obesity: A Secondary analysis of the PAC-MAnO trial

PURPOSE

The present study aimed to explore the influence of diet and physical activity (PA) changes on bone mineral content (BMC) and density (BMD) alterations in adolescents with obesity undergoing a weight loss program.

METHODS

Six-month longitudinal data from 71 adolescents (aged 15.1 [± 1.6] years; 57.7% girls) with a BMI z-score of 3.03 (± 0.78), previously recruited for the PAC-MAnO trial, were analyzed using Generalized Estimation Equations for over time changes and linear regressions with BMC, BMD and BMD z-score as dependent variables, adjusting for confounders (including type of exercise- aerobic vs. combined).

RESULTS

Adjusting for confounders, changes in carbohydrate (CH) and protein content showed to positively and negatively predict BMD z-score variance, respectively (β = 0.44, 95%CI: 0.01, 0.04, p < .001); β = -0.57, 95%CI: -0.06, -0.03, p < .001), yet no associations were found between PA and bone-related parameters. Combined exercise showed better results on BMC compared to aerobic exercise (β = 0.09, 95%CI: 0.05 to 0.13, p < .001).

CONCLUSIONS

Increased CH content, instead of protein, may be associated with BMD improvements in adolescents with obesity. Type of exercise may moderate the impact of PA on bone health.

TRIAL REGISTRATION

Clinicaltrials.gov NCT02941770. What is Known • Adolescents with obesity may be at a higher risk of osteopenia/osteoporosis • Obesity and inadequate diet and physical activity (PA) may have an adverse effect on bone metabolism What is New • Improvements in adiposity and muscle mass and increased diet carbohydrate content are associated with bone mineral density (BMD) improvements • Type of exercise (i.e., combined training vs. aerobic) may moderate the impact of PA on BMD, and calcium intake may mediate this impact.

Role of Serum Magnesium on Insulin Resistance in Overweight and Obese Children

Background Childhood obesity has become a global epidemic, with projections indicating it could affect 25% of children under 16 by 2050. This rise poses significant health risks, including early onset of type 2 diabetes and cardiovascular diseases. Recent research has shown a correlation between insulin action and magnesium levels, highlighting the link between low serum magnesium levels and obesity. This study aimed to investigate the relationship between serum magnesium levels and obesity in children aged 5-16 years, to compare overweight and obese adolescents with age- and gender-matched controls, and to determine the association between insulin resistance and decreased serum magnesium levels. Methodology At a tertiary hospital, this 1.5-year cross-sectional comparative study investigated the relationship between magnesium levels in the blood and insulin resistance in children aged 5-16. Cases met the 2015 revised Indian Academy of Pediatrics (IAP) growth charts for overweight or obesity in comparison to age-matched healthy controls. Exclusions included secondary causes of obesity and medical complications affecting magnesium. Assessments involved clinical history, examination, and fasting blood tests for insulin resistance indices. Results Compared to the controls, overweight children showed that mean serum magnesium levels are lower (1.03 mEq/l vs. 1.85 mEq/l, p<0.001); they were also reflected in higher anthropometric measures, which include body mass index (BMI) and body fat percentage. Cases had significantly higher metabolic markers like fasting insulin, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) index, and lipid profiles, whereas systolic blood pressure although showing recognized differences did not significantly differ. Conclusion The study underscored the importance of detecting magnesium levels on insulin resistance in overweight and obese children.

Farm to Fork Stability of Phytochemicals and Micronutrients in Brassica oleracea and Allium Vegetables

Brassica oleracea and Allium vegetables are known for their unique, family specific, water-soluble phytochemicals, glucosinolates, and S-alk(en)yl-l-cysteine sulfoxides, respectively. However, they are also important delivery systems of several other health-related compounds, such as carotenoids (lipid-soluble phytochemicals), vitamin C (water-soluble micronutrient), and vitamin K1 (lipid-soluble micronutrient). When all-year-round availability or transport over long distances is targeted for these often seasonal, locally grown vegetables, processing becomes indispensable. However, the vegetable processing chain, which consists of multiple steps (e.g., pretreatment, preservation, storage, preparation), can impact the nutritional quality of these vegetables corresponding to the nature of the health-related compounds and their susceptibility to (bio)chemical conversions. Since information about the impact of the vegetable processing chain is scattered per compound or processing step, this review targets an integration of the state of the art and discusses needs for future research. Starting with a discussion on substrate-enzyme location within the vegetable matrix, an overview is provided of the impact and potential of processing, encompassing a wide range of (nonenzymatic) conversions.

Maternal vitamin A and D status in second and third trimester of pregnancy and bone mineral content in offspring at nine years of age

Introduction

Maternal nutritional and vitamin status during pregnancy may have long-term effects on offspring health and disease. The aim of this study was to examine the associations between maternal vitamin A and D status in pregnancy and offspring bone mineral content (BMC) at nine years of age.

Methods

This is a post-hoc study of a randomized control trial including 855 pregnant women from two Norwegian cities; Trondheim and Stavanger. The women were randomized into an exercise intervention or standard antenatal care. Mother and child pairs for the present study were recruited from those still living in Trondheim after 8-10 years. Serum vitamin A (retinol) and vitamin D (25(OH)D) were measured in the 2nd and 3rd trimesters of pregnancy, and active vitamin D (1,25(OH)2D) in serum was measured in a subgroup. Spine BMC and trabecular bone score were measured in the children at nine years of age. Associations were analyzed with linear regression models.

Results

A total of 119 mother and child pairs were included in the analyses. Vitamin A insufficiency (retinol< 1.05 µmol/L) and vitamin D deficiency (25(OH)D< 50 mmol/L) increased from ~7% to ~43% and from ~28% to ~33%, respectively, from the 2nd to the 3rd trimester. An increase in serum 1,25(OH)2D from the 2nd to the 3rd trimester was observed in the subgroup. There was a negative association between serum retinol in the 2nd trimester and spine BMC in the boys, but not in the girls, when adjusted for maternal and child confounders. No other associations between maternal serum vitamin A or D and BMC in the children were found.

Conclusion

We observed a high prevalence of vitamin A insufficiency and vitamin D deficiency during pregnancy. A negative association between mid-pregnancy vitamin A status and spine BMC was observed in boys, but not girls, while no associations were found between maternal vitamin D status and child BMC. The implications of optimal vitamin A and D status in pregnancy for offspring bone health, remains a subject for further investigations.

Dietary Intake of Adolescents and Alignment with Recommendations for Healthy and Sustainable Diets: Results of the SI.Menu Study

BACKGROUND

The SI.Menu study offers the latest data on the dietary intake of Slovenian adolescents aged 10 to 17. The purpose of this study is to comprehensively assess their dietary intake (energy and nutrients) and compare their food intakes with dietary recommendations for healthy and sustainable diets.

METHODS

The cross-sectional epidemiological dietary study SI.Menu (March 2017-April 2018) was conducted on a representative sample of Slovenian adolescents aged 10 to 17 years (n = 468) (230 males and 238 females). Data on dietary intake were gathered through two non-consecutive 24 h recalls, in line with the European Food Safety Authority (EFSA) EU Menu methodology. The repeated 24 h Dietary Recall (HDR) and Food Propensity Questionnaire (FPQ) data were combined to determine the usual intakes of nutrients and food groups, using the Multiple Source Method (MSM) program.

RESULTS

Adolescents' diets significantly deviate from dietary recommendations, lacking vegetables, milk and dairy products, nuts and seeds, legumes, and water, while containing excessive meat (especially red meat) and high-sugar foods. This results in insufficient intake of dietary fibre, and nutrients such as vitamin D, folate, and calcium.

CONCLUSIONS

The dietary intake of Slovenian adolescents does not meet healthy and sustainable diet recommendations. This study provides an important insight into the dietary habits of Slovenian adolescents that could be useful for future public health strategies.

Combined full-length transcriptomic and metabolomic analysis reveals the molecular mechanisms underlying nutrients and taste components development in Primulina juliae

BACKGROUND

Primulina juliae has recently emerged as a novel functional vegetable, boasting a significant biomass and high calcium content. Various breeding strategies have been employed to the domestication of P. juliae. However, the absence of genome and transcriptome information has hindered the research of mechanisms governing the taste and nutrients in this plant. In this study, we conducted a comprehensive analysis, combining the full-length transcriptomics and metabolomics, to unveil the molecular mechanisms responsible for the development of nutrients and taste components in P. juliae.

RESULTS

We obtain a high-quality reference transcriptome of P. juliae by combing the PacBio Iso-seq and Illumina sequencing technologies. A total of 58,536 cluster consensus sequences were obtained, including 28,168 complete protein coding transcripts and 8,021 Long Non-coding RNAs. Significant differences were observed in the composition and content of compounds related to nutrients and taste, particularly flavonoids, during the leaf development. Our results showed a decrease in the content of most flavonoids as leaves develop. Malate and succinate accumulated with leaf development, while some sugar metabolites were decreased. Furthermore, we identified the different accumulation of amino acids and fatty acids, which are associated with taste traits. Moreover, our transcriptomic analysis provided a molecular basis for understanding the metabolic variations during leaf development. We identified 4,689 differentially expressed genes in the two developmental stages, and through a comprehensive transcriptome and metabolome analysis, we discovered the key structure genes and transcription factors involved in the pathways.

CONCLUSIONS

This study provides a high-quality reference transcriptome and reveals molecular mechanisms associated with the development of nutrients and taste components in P. juliae. These findings will enhance our understanding of the breeding and utilization of P. juliae as a vegetable.

Explainable machine learning for predicting the geographical origin of Chinese Oysters via mineral elements analysis

The traceability of geographic origin is essential for guaranteeing the quality, safety, and protection of oyster brands. However, the current outcomes of traceability lack credibility as they do not adequately explain the model's predictions. Consequently, we conducted a study to evaluate the efficacy of utilizing explainable machine learning combined with mineral elements analysis. The study findings revealed that 18 elements have the ability to determine regional orientation. Simultaneously, individuals should pay closer attention to the potential risks associated with oyster consumption due to the regional differences in essential and toxic elements they contain. Light gradient boosting machine (LightGBM) model exhibited indistinguishable performance, achieving flawless accuracy, precision, recall, F1 score and AUC, with values of 96.77%, 96.43%, 98.53%, 97.32% and 0.998, respectively. The SHapley Additive exPlanations (SHAP) method was used to evaluate the output of the LightGBM model, revealing differences in feature interactions among oysters from different provinces. Specifically, the features Na, Zn, V, Mg, and K were found to have a significant impact on the predictive process of the model. Consistent with existing research, the use of explainable machine learning techniques can provide insights into the complex connections between important product attributes and relevant geographical information.

Minerals and the Menstrual Cycle: Impacts on Ovulation and Endometrial Health

The role of minerals in female fertility, particularly in relation to the menstrual cycle, presents a complex area of study that underscores the interplay between nutrition and reproductive health. This narrative review aims to elucidate the impacts of minerals on key aspects of the reproductive system: hormonal regulation, ovarian function and ovulation, endometrial health, and oxidative stress. Despite the attention given to specific micronutrients in relation to reproductive disorders, there is a noticeable absence of a comprehensive review focusing on the impact of minerals throughout the menstrual cycle on female fertility. This narrative review aims to address this gap by examining the influence of minerals on reproductive health. Each mineral's contribution is explored in detail to provide a clearer picture of its importance in supporting female fertility. This comprehensive analysis not only enhances our knowledge of reproductive health but also offers clinicians valuable insights into potential therapeutic strategies and the recommended intake of minerals to promote female reproductive well-being, considering the menstrual cycle. This review stands as the first to offer such a detailed examination of minerals in the context of the menstrual cycle, aiming to elevate the understanding of their critical role in female fertility and reproductive health.

Calcium - a scoping review for Nordic Nutrition Recommendations 2023

The aim of this scoping review was to conduct evidence-based documentations between calcium (Ca) intake and health outcomes for updating dietary reference values (DRVs) and food-based dietary guidelines (FBDGs) in the sixth edition of Nordic Nutrient Recommendations (NNR2023). The systematic literature search was limited to reviews on human data published between 2011 and June 2021. Systematic reviews (SRs) and original publications of relevance for this scoping review were included. A common practice of designing studies on health outcomes related to Ca supplement intake is to examine combined Ca and vitamin D, and therefore, a combination of Ca with vitamin D (CaD) was included in this review. In total, 27 studies addressing the association between dietary or supplemental Ca on bone health, bone mineral density (BMD), pregnancy-related outcomes, cardiovascular diseases (CVD), cancers, obesity, and mortality were reviewed. SRs showed that both dietary and supplemental Ca intakes were positively associated with BMD, but evidence did not support the benefit in fracture prevention. Current evidence did not support that Ca or CaD supplementation increases risk of coronary heart disease or all-cause mortality in older adults, but that Ca may be beneficial for hypertension, especially in young people. Increasing Ca intake may be beneficial during pregnancy, especially for those at high risk of pre-eclampsia due to ethnicity, age, high BMI, and those with low baseline Ca intake. The associations between high Ca intake and cancers were varied, with strong evidence that high consumption of dairy products is protective against colorectal cancer and limited-suggestive evidence that dairy products and diets high in Ca might also be protective against breast cancer. Moreover, there is limited-suggestive evidence that dairy products and diets high in Ca increase the risk of prostate cancer. Based on current evidence, Ca intake is beneficial or neutral in relation to most of the outcomes evaluated in this review. Data from the Nordic countries show that average Ca intake is around the same as previously recommended by NNR. However, the average Ca intake in the Baltic countries is below the recommendations.

The Postprandial Calcium Absorption of a Milk-Derived Calcium Permeate - The Acute RENEW Double-Blinded Randomized Controlled Cross-Over Study

BACKGROUND

Studies suggest that dairy-derived calcium supplements have additional beneficial properties compared with other calcium supplements in relation to bone health.

OBJECTIVES

We investigated the postprandial calcium absorption from a milk-derived calcium permeate (CP) compared with calcium carbonate (CC).

METHODS

In this randomized double-blinded cross-over study, 10 healthy postmenopausal females (age 50-65 y) received maltodextrin (placebo), 800 mg calcium from CP or from CC provided in 6 capsules on separate days. A fasting blood sample was collected at baseline, 60, 120, 240, and 360 min after ingestion. At baseline and 360 min, spot-urine samples were collected. Serum-ionized calcium, intact parathyroid hormone, phosphorus, and magnesium were analyzed, as were urinary calcium, phosphorus, and magnesium. A linear mixed model was applied.

RESULTS

Serum-ionized calcium concentration after the CC supplement was higher at 240 min compared with the CP supplement [between-group difference; 95% confidence interval (CI): 0.039 mmol/L; 95% CI: 0.017-0.061; P = 0.00078]. Serum-ionized calcium concentration after the CC supplement was significantly higher than placebo at all postprandial time points except at 60 min. Urinary calcium concentration in 360 min spot urine was higher after intake of CC compared with CP [between-group difference; 95% CI: 2.47 mmol/L; 95% CI: 1.90-3.03; P = 0.0042].

CONCLUSIONS

Postprandial calcium absorption from CP was lower than that of CC, and concurrently, urinary concentration reflected increased serum appearance by CC compared with CP, highlighting different metabolic responses. The long-term and clinical implications should be studied further.

Association of Maternal Diet with Infant Birthweight in Women with Gestational Diabetes Mellitus

OBJECTIVE

This study aimed to explore the potential impact of pre-pregnancy and early pregnancy maternal nutrition on the incidence of small-for-gestational-age neonates (SGA) in women with gestational diabetes mellitus (GDM).

METHODS

A prospective cohort study was conducted between 2020 and 2022 at the 3rd Department of Obstetrics and Gynaecology (School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece). Pregnant women from routine care were surveyed about their dietary habits during two distinct periods: six months prior to pregnancy (period A) and from the onset of pregnancy until the oral glucose tolerance test at 24-28 gestational weeks (period B). The intake of various micronutrients and macronutrients was quantified from the questionnaire responses. Logistic regression models, adjusted for potential confounders including age, pre-pregnancy body mass index (BMI), smoking status, physical activity and parity, were used to evaluate the association between nutrient intake and small-for-gestational-age neonate incidence.

RESULTS

In total, 850 women were screened and of these, 90 (11%) were diagnosed with gestational diabetes mellitus and were included in the study. There were significant associations between the intake of specific nutrients and the occurrence of small-for-gestational-age neonates; higher fat intake compared to non-small for gestationa age during period B (aOR: 1.1, p = 0.005) was associated with an increased risk for small-for-gestational-age neonates, while lower intake of carbohydrates (g) (aOR: 0.95, p = 0.005), fiber intake (aOR: 0.79, p = 0.045), magnesium (aOR: 0.96, p = 0.019), and copper (aOR:0.01, p = 0.018) intake during period B were significantly associated with a decreased risk for small-for-gestational-age neonates.

CONCLUSIONS

The findings of this study highlight the potential role of maternal nutrition in modulating the risk of small for gestational age neonatesamong women with gestational diabetes mellitus. The results advocate for further research on the assessment and modification of both pre-pregnancy and early pregnancy nutrition for women, especially those at higher risk of gestational diabetes mellitus, to reduce the risk of gestational diabetes mellitus.

Consenso colombiano de la enfermedad inflamatoria intestinal pediátrica

Introducción: la colitis ulcerativa pediátrica (CUP), la enfermedad de Crohn pediátrica (ECP) y la enfermedad inflamatoria intestinal pediátrica no clasificable (EIIPNC) tienen particularidades clínicas y psicosociales que las diferencian de las del adulto y pueden condicionar enfoques terapéuticos distintos por las posibles repercusiones nutricionales, crecimiento y desarrollo, lo que representa un desafío para el pediatra y el gastroenterólogo. Objetivo: desarrollar recomendaciones basadas en la evidencia por consenso de expertos para el diagnóstico y el tratamiento oportunos y seguros de la enfermedad inflamatoria intestinal pediátrica (EIIP) en menores de 18 años, para los profesionales que atienden estos pacientes y los pagadores en salud. Metodología: a través de un panel de expertos del Colegio Colombiano de Gastroenterología, Hepatología y Nutrición Pediátrica (COLGAHNP) y un grupo multidisciplinario se formularon 35 preguntas en relación con el cuadro clínico, el diagnóstico y el tratamiento de la EIIP. A través de una revisión y un análisis crítico de la literatura, con especial énfasis en las principales guías de práctica clínica (GPC), estudios clínicos aleatorizados (ECA) y metaanálisis de los últimos 10 años, los expertos plantearon 77 recomendaciones que respondían a cada una de las preguntas de investigación con sus respectivos puntos prácticos. Posteriormente, cada una de las afirmaciones se sometieron a votación dentro del grupo desarrollador, incluyendo las afirmaciones que alcanzaron > 80 %. Resultados: todas las afirmaciones alcanzaron una votación > 80 %. La EIIP tiene mayor extensión, severidad y evolución hacia la estenosis, enfermedad perianal, manifestaciones extraintestinales y retraso en el crecimiento en comparación con los pacientes adultos, por lo que su manejo debe ser realizado por grupos multidisciplinarios liderados por gastroenterólogos pediatras y prepararlos para una transición a la edad adulta. Los criterios de Porto permiten una clasificación práctica de la EIIP. En la ECP, debemos usar la clasificación de París y debemos realizar ileocolonoscopia y esofagogastroduodenoscopia, ya que el 50 % tienen un compromiso superior, usando el SES-CD (UCEIS/Mayo en CUP) y tomando múltiples biopsias. Los laboratorios iniciales deben incluir marcadores de inflamación, calprotectina fecal y descartar infecciones intestinales. El tratamiento, la inducción y el mantenimiento de la EIIP deben ser individualizados y decididos según la estratificación de riesgo. En el seguimiento se debe usar el Pediatric Crohn Disease Activity Index (PCDAI) y Pediatric Ulcerative Colitis Activity Index (PUCAI) de las últimas 48 horas. Los pacientes con EIIP temprana e infantil, deben ser valorados por inmunólogos y genetistas. Conclusión: se proporciona una guía de consenso con recomendaciones basadas en la evidencia sobre el diagnóstico y los tratamientos oportunos y seguros en los pacientes con EIIP.

Whey Protein Dietary Supplements: Metal Exposure Assessment and Risk Characterization

Protein supplements (PS) are trendy foods, especially those made from whey. In addition to providing protein, these products are a source of metals, providing essential elements (Na, K, Mg, Ca, Mo, Mn, Fe, Co, Cu, and Zn) and other potentially toxic elements (Al, B, Sr, V Ba, and Ni). In this study, 47 whey PS samples were analyzed for mineral elements by ICP-OES, and their dietary exposures were assessed for three consumption scenarios. Elements found in higher concentrations were K (4689.10 mg/kg) and Ca (3811.27 mg/kg). The intake of 30 g PS (average recommended amount/day) provides about 20% of the established reference value (NRI) for Cr (18.30% for men and 25.63% for women) and Mo (26.99%). In a high daily consumption scenario (100 g PS/day) and when the maximum concentrations are considered, Cr, Zn, Fe, Mo, and Mg dietary intakes of these metals exceed the daily recommended intakes and could pose a risk. The daily intake of 30, 60, and 100 g of whey PS for 25 years does not pose a health risk since the hazard index (HI) is less than one in these consumption scenarios, and the essential elements contributing most to HI are Co, followed by Mo and Cr. It is recommended to improve the information to the consumers of these new products. Furthermore, to help in the management and prevention of these potential health risks, it would be advisable to improve the regulation of these dietary supplements and their labeling.

Associations of Dietary Intake and Nutrient Status with Micronutrient and Lipid Composition in Breast Milk of Donor Women

The influence of the diet and nutritional status of milk donors on the nutritional composition of donor human milk (DHM) is unknown. The present study aimed to determine the nutritional profile of DHM and the associations between donors' dietary intake and nutritional status and the micronutrient and lipid composition in DHM. For this purpose, 113 donors completed a food frequency questionnaire, provided a five-day weighed dietary record, and collected milk for five consecutive days. Nutrient determinations in donors' erythrocytes, plasma, urine, and milk were performed. Multiple linear regressions were conducted for the evaluation of the associations. We highlight the following results: DHM docosahexaenoic acid (DHA) was positively associated with donors' plasma DHA content and donors' DHA intake (R2 0.45, p < 0.001). For every 1 g/day DHA intake, an increase of 0.38% in DHA content and 0.78% in total omega-3 content was observed in DHM (R2 0.29, p < 0.001). DHM saturated fatty acids were positively associated with erythrocyte dimethyl acetals, plasma stearic acid, trans fatty acids intake, and breastfeeding duration and negatively associated with erythrocyte margaroleic acid (R2 0.34, p < 0.01). DHM cholecalciferol was associated with plasma cholecalciferol levels and dairy intake (R2 0.57, p < 0.01). Other weaker associations were found for free thiamin, free riboflavin, pyridoxal, dehydroascorbic acid, and the lipid profile in DHM. In conclusion, the diet and nutritional status of donors influence the fatty acid profile and micronutrient content of DHM.

EFSA Panel on Nutrition, Novel Foods and FoodAllergens (NDA), Turck D, Bohn T, Castenmiller J, de Henauw S, Hirsch‐Ernst K, Knutsen HK, Maciuk A, Mangelsdorf I, McArdle HJ, Pentieva K, Siani A, Thies F, Tsabouri S, Vinceti M, Lanham‐New S, Passeri G, Craciun I, Fabiani L, De Sousa RF, Martino L, Martínez SV, Naska A. Scientific opinion on the tolerable upper intake level for vitamin D, including the derivation of a conversion factor for calcidiol monohydrate

Following two requests from the European Commission (EC), the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver a scientific opinion on the revision of the tolerable upper intake level (UL) for vitamin D and to propose a conversion factor (CF) for calcidiol monohydrate into vitamin D3 for labelling purposes. Vitamin D refers to ergocalciferol (vitamin D2), cholecalciferol (vitamin D3), and calcidiol monohydrate. Systematic reviews of the literature were conducted to assess the relative bioavailability of calcidiol monohydrate versus vitamin D3 on serum 25(OH)D concentrations, and for priority adverse health effects of excess vitamin D intake, namely persistent hypercalcaemia/hypercalciuria and endpoints related to musculoskeletal health (i.e. falls, bone fractures, bone mass/density and indices thereof). Based on the available evidence, the Panel proposes a CF for calcidiol monohydrates of 2.5 for labelling purposes. Persistent hypercalciuria, which may be an earlier sign of excess vitamin D than persistent hypercalcaemia, is selected as the critical endpoint on which to base the UL for vitamin D. A lowest-observed-adverse-effect-level (LOAEL) of 250 μg/day is identified from two randomised controlled trials in humans, to which an uncertainty factor of 2.5 is applied to account for the absence of a no-observed-adverse-effect-level (NOAEL). A UL of 100 μg vitamin D equivalents (VDE)/day is established for adults (including pregnant and lactating women) and for adolescents aged 11-17 years, as there is no reason to believe that adolescents in the phase of rapid bone formation and growth have a lower tolerance for vitamin D compared to adults. For children aged 1-10 years, a UL of 50 μg VDE/day is established by considering their smaller body size. Based on available intake data, European populations are unlikely to exceed the UL, except for regular users of food supplements containing high doses of vitamin D.

Characterization of some Fagaceae kernels nutritional composition for potential use as novel food ingredients

The present study attempts to characterise Fagaceae kernels as a promising source of nutritional compounds for potential use as novel food ingredients. Thus, the proximate and mineral composition of some kernels (beech achene-BA, sessile oak acorn-SOA, turkey oak acorn-TOA, and red oak acorn-ROA), total phenolic content, individual polyphenols, and cytotoxicity of their aqueous extracts, respectively, the fatty acid composition of kernel oils were investigated using physicochemical and analytical techniques. Results revealed that BAK is rich in lipid and protein, OAKs in carbohydrates. All tested kernels contain high oleic-linoleic acid oils. BAK is abundant in phenolic acids, OAKs in hydrolysable tannins. Only BA and SOA kernels exert cytotoxicity against human fibroblasts. In all kernels, macroelements are dominated by K and microelements by Cu, Mn, and Fe. In conclusion, BA and OA kernels could be alternatively used as protein-rich, respectively, starch-rich ingredients in food.

Human Milk Composition and Nutritional Status of Omnivore Human Milk Donors Compared with Vegetarian/Vegan Lactating Mothers

Women of childbearing age in Western societies are increasingly adopting vegetarian diets. These women are sometimes rejected as milk donors, but little about the composition of their milk is known. The present study aimed to compare the intake, nutritional status, and nutritional composition of human milk from omnivore human milk donors (Donors) and vegetarian/vegan lactating mothers (Veg). Milk, blood, and urine samples from 92 Donors and 20 Veg were used to determine their fatty acid profiles, as well as vitamins and minerals. In a representative sample of both groups, we also determined the lipid class profile as a distribution of neutral and polar lipids, the molecular species of triacylglycerols, and the relative composition of phospholipids in their milk. A dietary assessment was conducted with a five-day dietary record (while considering the intake of supplements). We highlight the following results, expressed as the mean (SE), for the Veg vs. Donors: (1) Their docosahexaenoic acid (DHA) intake was 0.11 (0.03) vs. 0.38 (0.03) g/day; the plasma DHA was 0.37 (0.07) vs. 0.83 (0.06)%; and the milk DHA was 0.15 (0.04) vs. 0.33 (0.02)%. (2) Their milk B12 levels were 545.69 (20.49) vs. 482.89 (4.11) pM; 85% of the Veg reported taking B12 supplements (mean dose: 312.1 mcg/day); and the Veg group showed no differences with Donors in terms of total daily intake or plasma B12. (3) Their milk phosphatidylcholine levels were 26.88 (0.67) vs. 30.55 (1.10)%. (4) Their milk iodine levels were 126.42 (13.37) vs. 159.22 (5.13) mcg/L. In conclusion, the Vegs' milk was shown to be different from the Donors' milk, mainly due to its low DHA content, which is concerning. However, raising awareness and ensuring proper supplementation could bridge this gap, as has already been achieved for cobalamin.

Nutritional profiling and contaminant levels of five underutilized fish species in Norway

Exploring and making use of underutilized marine resources can be a sustainable approach to achieve future demands of fish consumption by the ever-growing population. Five species, namely European plaice (Pleuronectes platessa), European flounder (Platichthys flesus), lemon sole (Microstomus kitt), megrim (Lepidorhombus whiffiagonis), and thornback ray (Raja clavate), often captured as by-catch in Norway, were characterized for their nutritional value and potential accumulation of hazardous components. The proximate composition, protein profile, fatty acid profile as well as essential and toxic trace elements and polychlorinated biphenyls (PCBs) were analyzed. Digestible indispensable amino acid (DIAA) ratios and scores (DIAAS) and contributions of omega-3 fatty acids to the diet were calculated. Analysis on proximate composition revealed low fat contents of 0.74 to 1.25% and sufficient protein contents between 16.9 and 24% in the five species. Results of DIAA indicate a profitable distribution, with contributions exceeding the daily intake recommendations for an adult person related to a 200 g fillet. Moreover, findings on the distribution of eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) showed remarkable results, considering that the investigated species are lean fish. All five investigated fish exceed the recommended average daily intake level (AI) of EPA + DHA in a 200 g portion. As to toxic trace elements and PCBs, no significantly elevated levels were found considering a portion size of 200 g. Consequently, the nutritional quality of the investigated fish can be regarded as profitable with overall low potential health risks.

Sample Preparation and Analytical Techniques in the Determination of Trace Elements in Food: A Review

Every human being needs around 20 essential elements to maintain proper physiological processes. However, trace elements are classified as beneficial, essential, or toxic for living organisms. Some trace elements are considered essential elements for the human body in adequate quantities (dietary reference intakes, DRIs), while others have undetermined biological functions and are considered undesirable substances or contaminants. Pollution with trace elements is becoming a great concern since they can affect biological functions or accumulate in organs, causing adverse effects and illnesses such as cancer. These pollutants are being discarded in our soils, waters, and the food supply chain due to several anthropogenic factors. This review mainly aims to provide a clear overview of the commonly used methods and techniques in the trace element analysis of food from sample preparations, namely, ashing techniques, separation/extraction methods, and analytical techniques. Ashing is the first step in trace element analysis. Dry ashing or wet digestion using strong acids at high pressure in closed vessels are used to eliminate the organic matter. Separation and pre-concentration of elements is usually needed before proceeding with the analytical techniques to eliminate the interferences and ameliorate the detection limits.

Cow's Milk in Human Nutrition and the Emergence of Plant-Based Milk Alternatives

Cow's milk is considered a complete food, providing high-quality protein and essential micronutrients, including vitamins and minerals. For medical reasons or as a lifestyle choice, consumers are replacing cow's milk with plant-based milk alternatives (PBMA); some perceive them as healthier alternatives to cow's milk due to their low saturated fatty acid content and no cholesterol content. However, the nutritional composition of PBMA is quite variable between different types and even within, which makes a comparison with cow's milk a complex issue. Furthermore, the consumption of PBMA has been associated with the development of some diseases in infants and children. Meanwhile, the consumption of cow's milk in human health is a controversial issue since it has been associated with a favorable effect in some diseases (such as obesity, type 2 diabetes, and Alzheimer's) and a negative effect in others (such as prostate cancer risk and Parkinson's disease); while in some diseases, there is no consensus in the cow's milk consumption effect. The aim of this review is to make a nutritional comparison of cow's milk with PBMA and to clarify the potential health issues related to their consumption.

Quality of Calcium Food Supplements: Evaluation Compared to Manufacturers' Declarations

Calcium (Ca) is a macronutrient necessary for the proper functioning of an organism. In the case of insufficient consumption with diet, its deficiencies can be supplemented with food supplements (FS). These supplements are used, for example, as an auxiliary in the prevention of osteoporosis, allergies, hair loss or nail brittleness. The purpose of the study was to assess the compliance of Ca content with the manufacturers' declaration. The material consisted of 108 FS. Ca content was determined by atomic absorption spectrometry (AAS). It was shown that 1.9% of the samples were characterized by a Ca content that was too low in comparison to the manufacturer's declaration, while a content that was relatively too high was found in 54.6% of FS. The quality of FS should be monitored to ensure patient safety.

Calcium Biofortification of Rocha Pear Fruits: Implications on Mineral Elements, Sugars and Fatty Acids Accumulation in Tissues

Following an agronomic approach for the Ca enrichment of Rocha pears, this study aimed to assess the interactions between mineral nutrients in fruit tissues at harvest and after storage for 5 months and to characterize the implications on the profile of sugars and fatty acids (FA). A total of seven foliar sprays (with concentrations of 0.1–0.6 kg·ha−1 Ca(NO3)2 and 0.8–8 kg·ha−1 CaCl2) were applied to pear trees. After harvest, the fruits were stored for 5 months, in environmentally controlled chambers, and the mineral contents in five regions (on the equatorial section) of the fruits were assessed, while the sugar and FA content were quantified. For both dates, all foliar sprayed treatments, at different extends, increased Ca content in the center and near the epidermis of Rocha pear fruits and the levels of K, Mn, Fe, Zn and Cu also varied. At harvest, the Ca treatments did not affect the levels of sucrose, glucose, fructose and sorbitol and, after storage, their concentrations remained higher in Ca-treated fruits. Additionally, the tendency of the relative proportions of FA was C18:2 > C18:1 > C16:0 > C18:3 > C18:0 > chains inferior to 16 C (<16:0), but after storage it was C18:2 > C16:0 > C18:3 > C18:0 > C18:1 > chains inferior to 16 C (<16:0). It is concluded that the heterogeneous distribution of Ca in the tissues of Rocha pear fruits results from its absorption in the peel after Ca(NO3)2 and CaCl2 sprays and from the xylemic flux in the core prior to maturity. Additionally, the hydrolysis of complex polysaccharides affects the contents of simpler sugars during maturation, ripening and senescence, while storage decreases the amount of total fatty acids (TFA), but the double bond index (DBI) indicate that cell membrane fluidity remains unaffected.

Considerations for the translation of nutrient recommendations as dietary plans for infants, children, and adolescents as reported in Italian Guidelines for healthy eating

Healthy eating in childhood and adolescence is important for proper growth and development and to establish a healthy foundation for future dietary habits. This paper aims to describe the elaboration of dietary plans for pediatric ages highlighting critical points related to the application of the Italian nutrient recommendations. National databases on food composition data were used to compile the dietary plans. Starting from the definition of serving size for adults, the suggested portion size for pediatric ages was shaped to produce appropriate dietary plans according to the different classes of age. Items from “cereals and derivatives,” “milk,” “fruit,” “vegetables,” “olive oil,” and “water” groups were included daily. Pizza was included once a week. Sweets and snacks were gradually introduced, once a week in infants and up to five times a week in adolescents. Legumes were provided three times a week, as a source of vegetable and sustainable proteins. The main critical aspect of the dietary plans was related to the monotony, especially for snacks and breakfasts. This work demonstrated the limits of the translation of Italian nutrient recommendations into dietary plans for pediatric age groups. Keeping the protein intake in the recommended range of 8–12% of daily energy resulted in inadequate provision of calcium and iron. Other critical points were the reference values for body weight and physical activity. The proposed dietary plans are adequate with regard to food composition, the intake of energy and several nutrients, and in terms of food selection. However, their implementations require action, information, and advocacy.

Valorization of bio-waste eggshell as a viable source of dietary calcium for confectionery products

BACKGROUND

The market of innovative foods is developing very dynamically and consumers are paying increasingly more attention to the health properties of the food offered. In addition, many studies on food consumption indicate a deficiency of minerals in the diet and experts suggest that the consumption of fortified functional foods in a selected group of consumers may contribute to the improvement of their health and quality of life.

RESULTS

The aim of the work was to present the possibility of using bio-waste eggshell as a source of calcium in designing confectionery products. A snack with high calcium (0.567 g Ca kg^-1 of product) and fiber (11.44 g kg^-1 of product) content and potentially high calcium bioavailability was prepared. The results of the sensory expert-based assessment indicate a high (6-7 conventional units) overall sensory quality (OSQ) of the four flavor versions of the product during up to 3 months storage. In order to accurately illustrate the effect of storage time on the quality of the samples, texture analysis was carried out and the presented results indicate low correlations (r = -0.5554; r = -0.1494) between instrumentally measured hardness and sensory attribute of crispness, as well as hardness and OSQ, respectively.

CONCLUSION

It is possible to reuse bio-waste eggshells as a calcium-fortifying substance for food design. The addition of powdered eggshells to food is an interesting direction, both for nutritional reasons (high concentration of calcium and optimal bioavailability) and also for environmental protection (reduction of post-production waste). © 2021 Society of Chemical Industry.

Turck D, Bohn T, Castenmiller J, de Henauw S, Hirsch-Ernst KI, Knutsen HK, Maciuk A, Mangelsdorf I, McArdle HJ, Naska A, Peláez C, Pentieva K, Thies F, Tsabouri S, Vinceti M, Bresson JL, Siani A. Scientific advice related to nutrient profiling for the development of harmonised mandatory front-of-pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver scientific advice related to nutrient profiling for the development of harmonised mandatory front‐of‐pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods. This Opinion is based on systematic reviews and meta‐analyses of human studies on nutritionally adequate diets, data from the Global Burden of Disease framework, clinical practice guidelines, previous EFSA opinions and the priorities set by EU Member States in the context of their Food‐Based Dietary Guidelines and associated nutrient/food intake recommendations. Relevant publications were retrieved through comprehensive searches in PubMed. The nutrients included in the assessment are those likely to be consumed in excess or in inadequate amounts in a majority of European countries. Food groups with important roles in European diets have been considered. The Panel concludes that dietary intakes of saturated fatty acids (SFA), sodium and added/free sugars are above, and intakes of dietary fibre and potassium below, current dietary recommendations in a majority of European populations. As excess intakes of SFAs, sodium and added/free sugars and inadequate intakes of dietary fibre and potassium are associated with adverse health effects, they could be included in nutrient profiling models. Energy could be included because a reduction in energy intake is of public health importance for European populations. In food group/category‐based nutrient profiling models, total fat could replace energy in most food groups owing to its high‐energy density, while the energy density of food groups with low or no fat content may be well accounted for by the inclusion of (added/free) sugars. Some nutrients may be included in nutrient profiling models for reasons other than their public health importance, e.g. as a proxy for other nutrients of public health importance, or to allow for a better discrimination of foods within the same food category.

Nutritional recommendations for patients undergoing prolonged glucocorticoid therapy

Glucocorticoid (GC) therapy is a common treatment used in rheumatic and autoimmune diseases, owing to its anti-inflammatory and immunosuppressive effects. However, GC therapy can also induce a number of adverse effects, including muscle and bone loss, hypertension, metabolic perturbations and increased visceral adiposity. We review available evidence in this area and provide nutritional recommendations that might ameliorate these adverse effects. Briefly, optimizing calcium, vitamin D, sodium and protein intake and increasing consumption of unprocessed and minimally processed foods, while decreasing the consumption of ultra-processed foods, might counteract some of the specific challenges faced by these patients. Importantly, we identify a dearth of empirical data on how nutritional intervention might impact health-related outcomes in this population. Further research is required to investigate the clinical and therapeutic efficacy of these theory-based recommendations.

The Influence of Prophylactic Calcium and Magnesium Supplementation on Postoperative Quality of Life and Hypocalcemia After Total Thyroidectomy: Study Protocol for a Randomized Controlled Trial

Background: We want to investigate if a routine preoperative dietary supplementation of calcium and magnesium prior to thyroidectomy for nodular goiter and graves' disease can influence patients' outcome with regards to hypocalcemia associated symptoms and quality of life in order to reduce the risk of post-thyroidectomy hypocalcemia and to improve patient's quality of life.

Methods: The study will be conducted as a two-armed randomized controlled trial including patients scheduled for total thyroidectomy. Patients assigned to the intervention group will receive calcium carbonate and magnesium oxide starting 2 weeks preoperatively. Primary outcome is the postoperative quality of life measured by the ThyPRO-39 and EQ-5D questionnaires. Secondary outcome is the assessment of postoperative biochemical (calcium and PTH levels) and clinical hypocalcemia (symptoms as reported by the patient).

Discussion: A prophylactic dietary supplementation with calcium and magnesium, which could easily be implemented in the preoperative setting, could potentially help to avoid or reduce hypocalcemia-associated symptoms and improve quality of life. In the event of a positive outcome, this preoperative procedure can be an inexpensive way to prepare patients scheduled for thyroidectomy and can possibly reduce disease-specific costs by reducing the postoperative complication rate.

Clinical Trial Registration: DRKS00017195 in the German clinical trials register (Deutsches Register Klinischer Studien, DRKS) on the 22.05.2019.

Bone Health in School Age Children: Effects of Nutritional Intake on Outcomes

The maximum rate of bone mass accumulation is during early adolescence. As such, a focus on optimizing mineral nutrition in school age children, defined here as approximately 5 to 15 years of age, is crucial to minimize the risk of bone loss that occurs later in life leading to osteoporosis and fractures. Optimizing bone mass in this age group requires attention to an overall healthy diet including adequate calcium, phosphorus, magnesium, and vitamin D. Special concerns may exist related to children who follow a restricted diet such as a vegan diet, those with intolerance or allergies to dairy, and those with chronic health conditions including young adolescents with eating disorders. Public policy messages should focus on positive aspects of bone health nutrition in this age group and avoid overly specific statements about the exact amounts of foods needed for healthy bones. In this regard, dietary recommendations for minerals vary between North America and Europe and these are higher than the values that may be necessary in other parts of the world. The management of many children with chronic illnesses includes the use of medications that may affect their bone mineral metabolism. Routine lab testing for bone mineral metabolism including the serum 25-hydroxyvitamin D level is not indicated, but is valuable for at-risk children, especially those with chronic illnesses.

An overview of Structured Biosensors for Metal Ions Determination

The determination of metal ions is important for nutritional and toxicological assessment. Atomic spectrometric techniques are highly efficient for the determination of these species, but the high costs of acquisition and maintenance hinder the application of these techniques. Inexpensive alternatives for metallic element determination are based on dedicated biosensors. These devices mimic biological systems and convert biochemical processes into physical outputs and can be used for the sensitive and selective determination of chemical species such as cations. In this work, an overview of the proposed biosensors for metal ions determination was carried out considering the last 15 years of publications. Statistical data on the applications, response mechanisms, instrumentation designs, applications of nanomaterials, and multielement analysis are herein discussed.

Assessment of the Methods Used to Develop Vitamin D and Calcium Recommendations-A Systematic Review of Bone Health Guidelines

Background: There are numerous guidelines developed for bone health. Yet, it is unclear whether the differences in guideline development methods explain the variability in the recommendations for vitamin D and calcium intake. The objective of this systematic review was to collate and compare recommendations for vitamin D and calcium across bone health guidelines, assess the methods used to form the recommendations, and explore which methodological factors were associated with these guideline recommendations. Methods: We searched MEDLINE, EMBASE, CINAHL, and other databases indexing guidelines to identify records in English between 2009 and 2019. Guidelines or policy statements on bone health or osteoporosis prevention for generally healthy adults aged ≥40 years were eligible for inclusion. Two reviewers independently extracted recommendations on daily vitamin D and calcium intake, supplement use, serum 25 hydroxyvitamin D [25(OH)D] level, and sunlight exposure; assessed guideline development methods against 25 recommended criteria in the World Health Organization (WHO) handbook for guideline development; and, identified types identified types of evidence underpinning the recommendations. Results: we included 47 eligible guidelines from 733 records: 74% of the guidelines provided vitamin D (200~600–4000 IU/day) and 70% provided calcium (600–1200 mg/day) recommendations, 96% and 88% recommended vitamin D and calcium supplements, respectively, and 70% recommended a specific 25(OH)D concentration. On average, each guideline met 10 (95% CI: 9–12) of the total of 25 methodological criteria for guideline development recommended by the WHO Handbook. There was uncertainty in the association between the methodological criteria and the proportion of guidelines that provided recommendations on daily vitamin D or calcium. Various types of evidence, including previous bone guidelines, nutrient reference reports, systematic reviews, observational studies, and perspectives/editorials were used to underpin the recommendations. Conclusions: There is considerable variability in vitamin D and calcium recommendations and in guideline development methods in bone health guidelines. Effort is required to strengthen the methodological rigor of guideline development and utilize the best available evidence to underpin nutrition recommendations in evidence-based guidelines on bone health.

No effect of calcium and vitamin D intake on maternal blood pressure in a healthy pregnant population

OBJECTIVES

Clinical studies have reported an inverse relationship between calcium and vitamin D intake and hypertensive disorders of pregnancy (HDP). The aim of this study was to investigate if there was an association between calcium/vitamin D intake, and vitamin D (25OHD) status, and maternal blood pressure (BP), during pregnancy and at 5-year follow-up.

STUDY DESIGN

This was an observational study of 415 women who participated in the ROLO (Randomised cOntrolled trial of LOw glycaemic index diet for the prevention of recurrence of macrosomia) study. Maternal BP measurements were taken during each trimester and at 5-year follow-up. Calcium and vitamin D intake were determined at each trimester and 25OHD was measured in early and late pregnancy.

RESULTS

Over two-thirds of the cohort were vitamin D sufficient (25OHD > 30 nmol/L) and had adequate calcium intake (>750 mg/day). There was no correlation between calcium intake or vitamin D intake and maternal BP in trimester 1 to 3 or at 5-year follow-up. Vitamin D status at 13 weeks' gestation negatively correlated with mean arterial pressure in trimester 1 (r = -0.152, p = 0.044). There was no correlation however between 25OHD at 28 weeks' gestation and BP at 28 or 34 weeks' gestation or 25OHD and BP at 5-year follow-up.

CONCLUSIONS

In a healthy population of women with adequate calcium and vitamin D intake, no clinically significant correlation existed between calcium and vitamin D and maternal BP.

EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA), Turck D, Castenmiller J, De Henauw S, Hirsch‐Ernst KI, Kearney J, Maciuk A, Mangelsdorf I, McArdle HJ, Naska A, Peláez C, Pentieva K, Siani A, Thies F, Tsabouri S, Vinceti M, Cubadda F, Frenzel T, Heinonen M, Marchelli R, Neuhauser‐Berthold M, Poulsen M, Maradona MP, Schlatter JR, van Loveren H, Rossi A, Knutsen HK. Safety of calcium fructoborate as a novel food pursuant to Regulation (EU) 2015/2283

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver an opinion on calcium fructoborate as a novel food (NF) pursuant to Regulation (EU) 2015/2283. The NF, produced by chemical synthesis, contains a maximum of 2.9% of boron and on average 4.7% calcium and 84.2% fructose. It is intended to be marketed as food supplements targeting the general adult population, excluding pregnant and lactating women, at a maximum level of 220 mg/day (maximum boron intake of 6.4 mg per day). The combined intake of boron from the background diet and the NF is in the range of 9.6-9.9 mg/day (corresponding to up to 0.14 mg/kg body weight (bw) per day given a default bw of 70 kg). This is in the range of the acceptable daily intake (ADI) of 0.16 mg/kg bw per day. Under conditions mimicking the gastrointestinal (GI) environment, the NF is fully hydrolysed and the Panel considered boron toxicity relevant for the safety assessment. The Panel considers that there is no concern with respect to genotoxicity of the NF. The effect induced by the NF in a 13-week rat study is consistent with toxicological findings induced by treatment with boron compounds in animal studies. Epididymides-to-brain weight ratio was identified as the most relevant endpoint and the reference point derived was the lowest model averaged BMDL10 value of 529 mg/kg bw per day. This corresponds to 14.8 mg/kg bw per day of boron, which is higher than the critical no observed adverse effect level (NOAEL) (9.6 mg boron/kg bw per day) used for establishing the ADI of 0.16 mg/kg bw per day for boron. The Panel therefore applied the present ADI for boron in the assessment of the NF. The Panel concludes that the NF, calcium fructoborate, is safe under the proposed uses and use levels.

Traditional and Non-traditional Risk Factors for Osteoporosis in CKD

Osteoporosis is a state of bone fragility with reduced skeletal resistance to trauma, and consequently increased risk of fracture. A wide range of conditions, including traditional risk factors, lifestyle choices, diseases and their treatments may contribute to bone fragility. It is therefore not surprising that the multi-morbid patient with chronic kidney disease (CKD) is at a particularly high risk. CKD is associated with reduced bone quantity, as well as impaired bone quality. Bone fragility in CKD is a composite of primary osteoporosis, accumulation of traditional and uremia-related risk factors, assaults brought on by systemic disease, and detrimental effects of drugs. Some risk factors are modifiable and represent potential targets for intervention. This review provides an overview of the heterogeneity of bone fragility in CKD.

Development of functional whey cheese enriched in vitamin D3: nutritional composition, fortification, analysis, and stability study during cheese processing and storage

"Ricotta" cheese is a traditional and popular Italian fresh whey cheese commonly produced from cow's milk. Food fortification is an efficient strategy to reduce the high global prevalence of vitamin D deficiency. This study aims to study the chemical-nutritional analysis of ricotta cheese and to assess its suitability as a dairy matrix for vitamin D fortification. The chemical-nutritional analyses revealed that ricotta cheese is a good source of proteins (7.8 g/100 g) with high levels of branched-chain amino acids (1.8 g/100 g). Moreover, ricotta contains high levels of calcium (0.4 g/100 g) and phosphorus (0.2 g/100 g). 50 mg of vitamin D₃ were added to 95 kg of cheese reaching a mean fortification level of 41.4 ± 4.0 µg/100 g of ricotta cheese. The fortification study showed that vitamin D homogenously distributes in ricotta cheese after the homogenisation process. Moreover, vitamin D₃ has high heat stability (93.8 ± 1.8%) and remains stable throughout the shelf-life of the fortified food. This study demonstrates that ricotta cheese represents an ideal alternative dairy matrix for vitamin D₃ fortification.

Adequacy of calcium intake in Spanish population according age groups

This review shows the estimated calcium intake in Spain in recent years. Our results indicate that adolescents and the elderly are at risk of insufficient calcium intake. By using the national and the European recommendations, this work contributes to map and compare population's dietary calcium intake in the European countries. PURPOSE AND METHODS : The present work aims to examine calcium intake in the healthy Spanish population of any age and analyze its adequacy to the calcium Recommended Dietary Intake (RDI) for different groups in Spanish population, as well to the Adequate Intake (AI) or Population Reference Intake (PRI) estimated by European Food Safety Authority (EFSA). Forty-three studies published in the last 5 years were eligible for review. RESULTS AND CONCLUSIONS: The results show that infants and children exceed Spanish and EFSA dietary recommendations, adults meet more that 80% of the RDI and EFSA recommendations, and the estimated average calcium intake in the adolescent and elderly groups does not reach 75% of the recommended intake. Representative national studies with a common methodology to estimate calcium intake are needed.

The Use of a Nutrient Quality Score is Effective to Assess the Overall Nutritional Value of Three Brassica Microgreens

Microgreens have immense potential for improving dietary patterns, but little information is available regarding their overall nutritional value. We evaluated the nutritional traits of three hydroponically grown Brassica microgreens by using a Nutrient Quality Score. Micro cauliflower, micro broccoli and micro broccoli raab were grown using nutrient solutions with three different NH₄:NO₃ molar ratios (5:95, 15:85, and 25:75). Protein, dietary fiber, β-carotene, α-tocopherol and mineral elements (Ca, K, Mg, Fe, Zn, Cu, Mn, and Na) were analyzed. We developed the Nutrient Quality Score (NQS 11.1) on the basis of 11 desirable nutrients and 1 nutrient (sodium) to be limited. All Brassica microgreens are an excellent source of Vitamins A and E (more than 20% of the daily reference value—DRV), as well as a good source of calcium and manganese (10–19% of the DRV). Micro cauliflower showed a NQS 11.1 at 47% higher than micro broccoli raab and micro broccoli. Using NH₄:NO₃ 25:75 molar ratio, the average score was 27% higher than other molar ratios. In all cases, the microgreens in the present study showed a higher NQS 11.1 than their mature counterpart (on the basis of data from the United States Department of Agriculture), highlighting that the score of micro cauliflower was about six-fold higher than mature cauliflower. In conclusion, the NQS 11.1 was useful for assessing the overall nutritional quality of the three Brassica microgreens, instead of simply quantifying nutrient content, in order to compare a single nutrient among different genotypes. Furthermore, the results highlight that the micro broccoli raab, micro broccoli and micro cauliflower in this study can be considered nutrient-rich vegetables that are able to improve dietary patterns more effectively than their mature counterparts.