Hidden Hunger: Solutions for America's Aging Populations

Food Insecurity, Race and Ethnicity, and Cognitive Function Among United States Older Adults

BACKGROUND

Cognitive impairment and dementia are severe public health issues in aging populations, which can be exacerbated by insufficient or unhealthy dietary intake. Food (in)security status is linked to cognitive function among older adults, but the relationship is complex and can vary by sociodemographic characteristics.

OBJECTIVE

This article aimed to investigate the association between food insecurity and cognitive function among United States older adults and explore potential variations by race and ethnicity groups.

METHODS

We prospectively examined changes in cognitive function and incidence of cognitive impairment alongside the presence of self-reported food insecurity among older adults of different racial and ethnic groups. Data were from the 2012-2018 Health and Retirement Study (HRS) and the 2013 Health Care and Nutrition Study (HCNS), including N = 6,638 United States adults aged 50 years and older. Food insecurity was measured by a self-reported United States Household Food Security Survey Module, and cognitive function was assessed by the modified version of the Telephone Interview for Cognitive Status.

RESULTS

Results showed that 17% of United States older adults reported food insecurity in the 2013 HCNS. Compared with food secure older adults, those reporting food insecurity experienced worsened cognitive functioning over time (B = -0.63, p < .001), and they were more likely to have onset of cognitive impairment (OR= 1.46, p < .001) in the 6-y observation. Compared with non-Hispanic White older adults, being non-Hispanic Black, non-Hispanic Other, or Hispanic was associated with 2.96, 2.09, or 1.26 odds (p < .001) of cognitive impairment (2012-2018), respectively. Older adults of racial and ethnic minority groups also had higher risks of experiencing the double burden of cognitive impairment alongside food insecurity compared with non-Hispanic White older adults.

CONCLUSION

Findings underscore racial and ethnic structural disparities in food security and cognitive health in the United States aging population.

Consideration for Flavonoid-Containing Dietary Supplements to Tackle Deficiency and Optimize Health

Randomized clinical trials (RCT) and observational studies have highlighted the importance of flavonoid consumption for human health. Several studies have associated a high intake of dietary flavonoids with (a) enhanced metabolic and cardiovascular health, (b) enhanced cognitive and vascular endothelial functions, (c) an improved glycemic response in type 2 diabetes mellitus, and (d) a reduced risk of breast cancer in postmenopausal women. Since flavonoids belong to a broad and diverse family of polyphenolic plant molecules-with more than 6000 compounds interspersed in the human diet-researchers are still uncertain whether the intake of single, individual polyphenols or a large combination of them (i.e., synergistic action) can produce the greatest health benefits for humans. Furthermore, studies have reported a poor bioavailability of flavonoid compounds in humans, which presents a major challenge for determining their optimal dosage, recommended intake, and, consequently, their therapeutic value. Especially because of their scarce bioavailability from foods-along with the overall declining food quality and nutrient density in foods-the role of flavonoid supplementation may become increasingly important for human health. Although research shows that dietary supplements can be a highly useful tool to complement diets that lack sufficient amounts of important nutrients, some caution is warranted regarding possible interactions with prescription and non-prescription drugs, especially when taken concurrently. Herein, we discuss the current scientific basis for using flavonoid supplementation to improve health as well as the limitations related to high intakes of dietary flavonoids.

Proposal to Screen for Zinc and Selenium in Patients with IgA Deficiency

The increase in life expectancy can be a consequence of the world's socioeconomic, sanitary and nutritional conditions. Some studies have demonstrated that individuals with a satisfactory diet variety score present a lower risk of malnutrition and better health status. Zinc and selenium are important micronutrients that play a role in many biochemical and physiological processes of the immune system. Deficient individuals can present both innate and adaptive immunity abnormalities and increased susceptibility to infections. Primary immunodeficiency diseases, also known as inborn errors of immunity, are genetic disorders classically characterized by an increased susceptibility to infection and/or dysregulation of a specific immunologic pathway. IgA deficiency (IgAD) is the most common primary antibody deficiency. This disease is defined as serum IgA levels lower than 7 mg/dL and normal IgG and IgM levels in individuals older than four years. Although many patients are asymptomatic, selected patients suffer from different clinical complications, such as pulmonary infections, allergies, autoimmune diseases, gastrointestinal disorders and malignancy. Knowing the nutritional status as well as the risk of zinc and selenium deficiency could be helpful for the management of IgAD patients.

OBJECTIVES

to investigate the anthropometric, biochemical, and nutritional profiles and the status of zinc and selenium in patients with IgAD.

METHODS

in this descriptive study, we screened 16 IgAD patients for anthropometric and dietary data, biochemical evaluation and determination of plasma and erythrocyte levels of zinc and selenium.

RESULTS

dietary intake of zinc and selenium was adequate in 75% and 86% of the patients, respectively. These results were consistent with the plasma levels (adequate levels of zinc in all patients and selenium in 50% of children, 25% of adolescents and 100% of adults). However, erythrocyte levels were low for both micronutrients (deficiency for both in 100% of children, 75% of adolescents and 25% of adults).

CONCLUSION

our results highlight the elevated prevalence of erythrocyte zinc and selenium deficiency in patients with IgAD, and the need for investigation of these micronutrients in their follow-up.

Health Effects of Whole Grains: A Bibliometric Analysis

Whole grains have been recommended in the diet in most countries, with numerous publications focusing on their health effect. A systematic analysis of these publications on different research methods, regions and perspectives will contribute to an understanding of the innovation pattern in this field. This bibliometric study analyzes the global publication characteristics, hotspots and frontiers of whole grain health benefit research, and discusses the trends and prospects of this topic. The overall number of publications is on the rise, with the United States contributing the most publications. The most cited literature shows that observational studies, systematic reviews and meta-analysis are the most widely used methods. The main focus in this area is on dietary fiber and bioactive substances, while the latter has received increased attention in recent years in particular. With the increasingly prominent problems of hidden hunger and chronic disease, the development of whole grain foods and their optimum intake have gradually become hot topics. In addition to the need to reveal the mechanism of whole grain health effects, consensus needs to be reached on standards and definitions for whole grain foods, and attention should be paid to the retention of taste and healthy nutrients in processing.

Protein Intake and Oral Health in Older Adults-A Narrative Review

Oral health is vital to general health and well-being for all ages, and as with other chronic conditions, oral health problems increase with age. There is a bi-directional link between nutrition and oral health, in that nutrition affects the health of oral tissues and saliva, and the health of the mouth may affect the foods consumed. Evidence suggests that a healthy diet generally has a positive impact on oral health in older adults. Although studies examining the direct link between oral health and protein intake in older adults are limited, some have explored the relationship via malnutrition, which is also prevalent among older adults. Protein-energy malnutrition (PEM) may be associated with poor oral health, dental caries, enamel hypoplasia, and salivary gland atrophy. This narrative review presents the theoretical evidence on the impact of dietary protein and amino acid composition on oral health, and their combined impact on overall health in older adults.

Nutrition, Immunosenescence, and Infectious Disease: An Overview of the Scientific Evidence on Micronutrients and on Modulation of the Gut Microbiota

The immune system is key to host defense against pathogenic organisms. Aging is associated with changes in the immune system, with a decline in protective components (immunosenescence), increasing susceptibility to infectious disease, and a chronic elevation in low-grade inflammation (inflammaging), increasing the risk of multiple noncommunicable diseases. Nutrition is a determinant of immune cell function and of the gut microbiota. In turn, the gut microbiota shapes and controls the immune and inflammatory responses. Many older people show changes in the gut microbiota. Age-related changes in immune competence, low-grade inflammation, and gut dysbiosis may be interlinked and may relate, at least in part, to age-related changes in nutrition. A number of micronutrients (vitamins C, D, and E and zinc and selenium) play roles in supporting the function of many immune cell types. Some trials report that providing these micronutrients as individual supplements can reverse immune deficits in older people and/or in those with insufficient intakes. There is inconsistent evidence that this will reduce the risk or severity of infections including respiratory infections. Probiotic, prebiotic, or synbiotic strategies that modulate the gut microbiota, especially by promoting the colonization of lactobacilli and bifidobacteria, have been demonstrated to modulate some immune and inflammatory biomarkers in older people and, in some cases, to reduce the risk and severity of gastrointestinal and respiratory infections, although, again, the evidence is inconsistent. Further research with well-designed and well-powered trials in at-risk older populations is required to be more certain about the role of micronutrients and of strategies that modify the gut microbiota-host relationship in protecting against infection, especially respiratory infection.

Rate of Nutrition-Related Chronic Diseases Among a Multi-Ethnic Group of Uninsured Adults

The prevalence of nutrition-related chronic diseases, such as obesity, cardiovascular disease, and type 2 diabetes, among adults in the U.S. is of increasing importance. These conditions adversely affect the overall public health, health care systems, and economy. Marginalized minority groups have been disproportionally affected by these conditions. Lack of or inadequate health insurance limits access to health care, which contributes to poor health outcomes among individuals with these conditions. South Florida is home to diverse racial/ethnic minority groups, many of whom are uninsured and do not have access to expert-delivered nutrition education services. It is imperative to thoroughly study the health needs of these underserved patient populations and examine the rate of nutrition-related conditions among them in order to develop medically and culturally tailored nutrition education programs for them. Therefore, the aim of this study was to assess the prevalence of nutrition-related diseases among multi-racial/ethnic uninsured individuals living in South Florida. A four-week electronic health record of adult patients (N=272) from a free clinic in South Florida was analyzed. Spearman`s correlation and binary regression models were used to assess the relationship between the variables. The sample included females (65%) and males (35%). The mean age was 49.08±14.56 years. Overall, 87% had at least one nutrition-related condition, with overweight/obesity being the most observed (75.2%), followed by hypertension (39%), dyslipidemia (27.2%), and diabetes (23.9%). BMI was a significant predictor of the prevalence of hypertension among Whites (p=0.008) and Blacks (p=0.002) but not Asians (p=0.536). Overall, a high rate of nutrition-related chronic diseases was found among uninsured adults in this study. This supports the need for increased medically, culturally, and economically tailored nutrition education programs in free clinic settings.

Transcriptome-wide association and prediction for carotenoids and tocochromanols in fresh sweet corn kernels

Sweet corn (Zea mays L.) is consistently one of the most highly consumed vegetables in the United States, providing a valuable opportunity to increase nutrient intake through biofortification. Significant variation for carotenoid (provitamin A, lutein, zeaxanthin) and tocochromanol (vitamin E, antioxidants) levels is present in temperate sweet corn germplasm, yet previous genome-wide association studies (GWAS) of these traits have been limited by low statistical power and mapping resolution. Here, we employed a high-quality transcriptomic dataset collected from fresh sweet corn kernels to conduct transcriptome-wide association studies (TWAS) and transcriptome prediction studies for 39 carotenoid and tocochromanol traits. In agreement with previous GWAS findings, TWAS detected significant associations for four causal genes, β-carotene hydroxylase (crtRB1), lycopene epsilon cyclase (lcyE), γ-tocopherol methyltransferase (vte4), and homogentisate geranylgeranyltransferase (hggt1) on a transcriptome-wide level. Pathway-level analysis revealed additional associations for deoxy-xylulose synthase2 (dxs2), diphosphocytidyl methyl erythritol synthase2 (dmes2), cytidine methyl kinase1 (cmk1), and geranylgeranyl hydrogenase1 (ggh1), of which, dmes2, cmk1, and ggh1 have not previously been identified through maize association studies. Evaluation of prediction models incorporating genome-wide markers and transcriptome-wide abundances revealed a trait-dependent benefit to the inclusion of both genomic and transcriptomic data over solely genomic data, but both transcriptome- and genome-wide datasets outperformed a priori candidate gene-targeted prediction models for most traits. Altogether, this study represents an important step toward understanding the role of regulatory variation in the accumulation of vitamins in fresh sweet corn kernels.

Nutritional Value of Canteen Menus and Dietary Habits and Intakes of University Students in Indonesia

A comprehensive assessment of the dietary status of university students in Indonesia is lacking. Hence, this study aims to assess students' dietary habits, status, and the nutritive value of meals offered at university canteens. This was a cross-sectional study based on the dietary habits of 333 students, 26 of whom were interviewed for the dietary survey. The nutritional value of canteen menus used by nearly half of the students (44%) was also examined. Most menus lacked macro and micronutrients (i.e., calcium, 15.5%) and were high in salt (181.5%). BMIs showed malnutrition among students (38.5%). The protein, fat, carbohydrate (PFC) ratio showed a high proportion of fat (32.4%) in the diets of female students. The level of salt intake (96.2%) was above the Indonesian recommended dietary allowance (RDA). Most students had unhealthy dietary patterns, including a high consumption of sweet beverages and instant noodles and a low intake of fruits, vegetables, animal protein, and milk. The lack of nutrients in canteen menus might lead to a nutrient deficiency among the students, which underlines the important role of canteens in the students' dietary intake. Optimizing the nutritional profile of menus, labeling based on nutrient profiling, and promoting nutrition education should be addressed to improve students' diets.

Effects of food neophobia and oral health on the nutritional status of community-dwelling older adults

BACKGROUND

Food preferences and oral health of older adults greatly affect their nutritional intake, and old-age-related increase in food neophobia may consequently reduce food intake in older adults. This study aimed to determine the impact of food neophobia and oral health on nutritional risk in community-dwelling older adults.

METHODS

This cross-sectional study included 238 independent adults aged ≥ 65 years (mean, 76.3 ± 7.3 years). The survey items included a Food Neophobia Scale, frequency of protein intake, oral-health-related quality of life (QOL) assessment, and oral diadochokinesis (ODK; /pa/, /ta/, /ka/) as an index of oral function. Nutritional status was assessed using the Mini Nutritional Assessment®, and based on a cutoff value of 24 points, respondents were categorized as well-nourished (≥ 24 points, Group 1) or at risk of malnutrition (< 24 points, Group 2). A logistic regression model was used to calculate the adjusted odds ratio (adj-OR) with 95% confidence interval (CI) to identify risks factors for malnutrition associated with food neophobia and oral health.

RESULTS

Factors associated with the risk of malnutrition in the older population were higher food neophobia (adj-OR = 1.036, 95% CI: 1.007-1.067) and lower oral function (OR = 0.992, 95% CI: 0.985-0.999) and lower oral-health-related QOL (adj-OR = 0.963, 95% CI: 0.929-0.999).

CONCLUSIONS

Older adults at risk of developing malnutrition may have higher food neophobia and lower oral function and oral-health-related QOL. Factors contributing to preventing malnutrition include predicting the risk of malnutrition based on the oral health indicators that older people are aware of, signs appearing in the oral cavity, minor deterioration, and providing dietary guidance about food neophobia. Notably, these approaches represent novel strategies for nutrition support that can be implemented based on a multifaceted understanding of the eating habits of older adults.

Zinc-biofortified staple food crops to improve zinc status in humans: a systematic review

Biofortified foods are a new approach to increase minerals in the diet, and evidence suggests that zinc (Zn) biofortification can improve Zn physiological status in humans. This systematic review aimed to answer the question: "What are the effects of the consumption of Zn biofortified foods on Zn status in humans?". This review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD42021250566). PubMed, Cochrane, Scopus and Science Direct databases were searched for studies that evaluated the effects of Zn biofortified foods on Zn absorption. Of 4282 articles identified, nine remained after inclusion/exclusion criteria were applied. Limitations in study quality, external and internal validity (bias/confounding), and study power were evaluated. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the certainty of evidence. Of the nine articles included, five observed an increase in total Zn absorption, and one showed that Zn participated in the conversion of linoleic acid to dihomo-γ-linolenic acid. By increasing the amount of Zn in the food, Zn biofortification can reduce the phytate:Zn molar ratio and improve Zn absorption in humans. More studies are needed to clarify what portion of Zn biofortified foods/day is needed to achieve a significant effect on Zn status.

Food Insecurity in Older Adults in Canada and the United States: A Concept Analysis

A concept analysis using the method of Walker and Avant was undertaken to clarify the concept of food insecurity in older adults in Canada and the United States. A literature review was undertaken to conduct a concept analysis of food insecurity in older people. Food insecurity is associated with multiple negative health outcomes and may be experienced differently by older adults as compared to younger adults. It is therefore important to understand the concept of food insecurity as is relates to older adults. Four defining attributes of food insecurity in older adults in Canada and the United States were identified: (i) inability to acquire or prepare enough food, (ii) compromising on food quality or preference, (iii) uncertainty or anxiety around the ability to acquire or prepare food, and (iv) socially unacceptable or non-normative practices. These attributes may allow for improved policies and programs aimed at addressing food insecurity in older adults by better meeting the needs of older individuals. Additional research into food insecurity as experienced by Canadian and American older adults could help to further clarify the concept.

The Role of Micronutrients in Ageing Asia: What Can Be Implemented with the Existing Insights

Life expectancy as a measure of population health does not reflect years of healthy life. The average life expectancy in the Asia-Pacific region has more than doubled since 1900 and is now above 70 years. In the Asia-Pacific region, the proportion of aged people in the population is expected to double between 2017 and 2050. Increased life expectancy leads to an increase in non-communicable diseases, which consequently affects quality of life. Suboptimal nutritional status is a contributing factor to the prevalence and severity of non-communicable diseases, including cardiovascular, cognitive, musculoskeletal, immune, metabolic and ophthalmological functions. We have reviewed the published literature on nutrition and healthy ageing as it applies to the Asia-Pacific region, focusing on vitamins, minerals/trace elements and omega-3 fatty acids. Optimal nutritional status needs to start before a senior age is reached and before the consequences of the disease process are irreversible. Based on the nutritional status and health issues in the senior age in the region, micronutrients of particular importance are vitamins A, D, E, C, B-12, zinc and omega-3 fatty acids. The present paper substantiates the creation of micronutrient guidelines and proposes actions to support the achievement of optimal nutritional status as contribution to healthy ageing for Asia-Pacific populations.

Chemical Stability of the Fertilizer Chelates Fe-EDDHA and Fe-EDDHSA over Time

In application conditions, the influence of environmental parameters on used fertilizer chelates and their distribution over time is important. For this purpose, the changes in the content of micronutrient ions and Fe-EDDHA and Fe-EDDHSA chelates in an aqueous medium at different pH values were studied. In the assumed time, changes in the ions content were analyzed using the voltammetry method at pH 3, 5 and 7. The content of isomers and chelate forms was analyzed by ion pair chromatography at pH 3, 5 and 7. These studies allowed us to determine the effect of pH on the stability of iron chelates over time.

The Role of Oat Nutrients in the Immune System: A Narrative Review

Optimal nutrition is the foundation for the development and maintenance of a healthy immune system. An optimal supply of nutrients is required for biosynthesis of immune factors and immune cell proliferation. Nutrient deficiency/inadequacy and hidden hunger, which manifests as depleted nutrients reserves, increase the risk of infectious diseases and aggravate disease severity. Therefore, an adequate and balanced diet containing an abundant diversity of foods, nutrients, and non-nutrient chemicals is paramount for an optimal immune defense against infectious diseases, including cold/flu and non-communicable diseases. Some nutrients and foods play a larger role than others in the support of the immune system. Oats are a nutritious whole grain and contain several immunomodulating nutrients. In this narrative review, we discuss the contribution of oat nutrients, including dietary fiber (β-glucans), copper, iron, selenium, and zinc, polyphenolics (ferulic acid and avenanthramides), and proteins (glutamine) in optimizing the innate and adaptive immune system's response to infections directly by modulating the innate and adaptive immunity and indirectly by eliciting changes in the gut microbiota and related metabolites.

Application of Ohmic-Vacuum Combination Heating for the Processing of Senior-Friendly Food (Multiphase Food): Experimental Studies and Numerical Simulation

The popularity of senior-friendly food has been increasing as the world enters the age of an aging society. It is required that senior-friendly food products are processed with the new concept of processing techniques that do not destroy the nutritional and sensory values. Ohmic heating can be an alternative to conventional heating methods for processing senior-friendly food with retaining excellent taste and quality because of less destruction of nutrients in the food. In this study, the ohmic–vacuum combination heating system was developed to process a multiphase type of senior-friendly food. Changes in physical and electrical properties of senior-friendly model foods were investigated depending on the experimental conditions such as vacuum pressure intensity and vacuum pretreatment time. Numerical simulations based on the experimental conditions were performed using COMSOL multiphysics. The ohmic–vacuum combination heating method with agitation reduced the heating time of the model food, and non-uniform temperature distribution in model food was successfully resolved due to the effect of vacuum and agitation. Furthermore, the difference was found in the hardness of solid particles depending on the vacuum treatment time and intensity after the heating treatment. The ohmic–vacuum combination heating system appeared effective when applying for the senior-friendly foods in multiphase form. The simulation results matched reasonably well with the experimental data, and the data predicted through simulation could save the cost and time of experimentation.

Effects of Iron and Zinc Biofortified Foods on Gut Microbiota In Vivo (Gallus gallus): A Systematic Review

Dietary iron and zinc deficiencies are a global health concern. Bacteria that colonize the gastrointestinal tract depend on minerals to maintain their activities; thus, recent evidence suggests that biofortified foods can modulate the host’s beneficial bacterial taxa. The current review analyzed the research data that linked between iron and zinc biofortified foods and gut microbiota modulation. The data analysis was based on the PRISMA guidelines and the data search was performed at PubMed, Web of Science, Science Direct, and Scopus databases for experimental studies published from January 2010 until December 2020. The five selected studies were conducted in an experimental in vivo model (Gallus gallus). The identified and discussed research showed positive effects of biofortified foods on the composition and function of the gut microbiota. Further, an increase in short chain fatty acids producing bacterial populations as Lactobacillus and Ruminococcus, and a decrease in potentially pathogenic bacteria as Streptococcus, Escherichia, and Enterobacter was identified due to the consumption of biofortified foods. In conclusion, biofortified foods may contribute to improved gut health without increasing the colonization of pathogenic bacteria. The dietary inclusion of approximately 50% of iron/zinc biofortified foods has a significant beneficial effect on the gut microbiota. Additional studies in humans and animal models are warranted to further establish the suggested effects on the intestinal microbiome. PROSPERO (CRD42020184221).

Nutritional Assessment in Older Adults : MNA® 25 years of a Screening Tool and a Reference Standard for Care and Research; What Next?

A tool to assess nutritional status in older persons was really needed. It took 5 years to design the MNA® (Mini Nutrition Assessment) tool, complete the first validations studies both in Europe and in the U.S. and to publish it. After the full MNA®, the MNA® short form and the self-MNA® have been validated. As well as Chinese and other national MNA® forms. Now more than 2000 clinical research have used the MNA® all over the world from community care to hospital. At least 22 Expert groups included the MNA® in new clinical practice guidelines, national or international registries. The MNA® is presently included in almost all geriatric and nutrition textbook and part of the teaching program for medicine and other health care professional worldwide. The urgent need is to target the frail older adults more likely to have weight loss and poor appetite and to prevent frailty and weight loss in the robust. We present in this paper the review of 25 years of clinical research and practice using the MNA® worldwide.

Older adults with obesity have higher risks of some micronutrient inadequacies and lower overall dietary quality compared to peers with a healthy weight, National Health and Nutrition Examination Surveys (NHANES), 2011-2014

OBJECTIVE

To evaluate total usual intakes and biomarkers of micronutrients, overall dietary quality and related health characteristics of US older adults who were overweight or obese compared with a healthy weight.

DESIGN

Cross-sectional study.

SETTING

Two 24-h dietary recalls, nutritional biomarkers and objective and subjective health characteristic data were analysed from the National Health and Nutrition Examination Survey 2011-2014. We used the National Cancer Institute method to estimate distributions of total usual intakes from foods and dietary supplements for eleven micronutrients of potential concern and the Healthy Eating Index (HEI)-2015 score.

PARTICIPANTS

Older adults aged ≥60 years (n 2969) were categorised by sex and body weight status, using standard BMI categories. Underweight individuals (n 47) were excluded due to small sample size.

RESULTS

A greater percentage of obese older adults compared with their healthy-weight counterparts was at risk of inadequate Mg (both sexes), Ca, vitamin B6 and vitamin D (women only) intakes. The proportion of those with serum 25-hydroxyvitamin D < 40 nmol/l was higher in obese (12 %) than in healthy-weight older women (6 %). Mean overall HEI-2015 scores were 8·6 (men) and 7·1 (women) points lower in obese than in healthy-weight older adults. In addition, compared with healthy-weight counterparts, obese older adults were more likely to self-report fair/poor health, use ≥ 5 medications and have limitations in activities of daily living and cardio-metabolic risk factors; and obese older women were more likely to be food-insecure and have depression.

CONCLUSIONS

Our findings suggest that obesity may coexist with micronutrient inadequacy in older adults, especially among women.

Vitamin Status and Diet in Elderly with Low and High Socioeconomic Status: The Lifelines-MINUTHE Study

Socioeconomic health inequalities are an important global public health problem. However, it is not well known to what extent socioeconomic inequalities culminate in impaired vitamin status and whether this is mediated by diet. We, therefore, aimed to assess vitamin status in a population already at increased risk of micronutrient deficiency, i.e., elderly with high and low socioeconomic status (SES), and to investigate whether potential differences therein were mediated by diet quality. Vitamin status in 1605 individuals (60–75 years) from the Lifelines- Micronutrients and Health inequalities in Elderly (MINUTHE) Study was assessed by measuring folic acid and the vitamins B6, B12, D, A, E, and K. Multinomial logistic and linear regression analyses were applied to test the associations between SES and vitamin status. Mediation analysis was used to explore the interrelationship between SES, diet quality, and vitamin status. Low SES was associated with poorer status of vitamin B6, vitamin B12, and, notably, folic acid. Moreover, multivitamin deficiencies were more prevalent in the low SES group. Diet quality was found to mediate the associations of SES with folic acid (for 39.1%), vitamin B6 (for 37.1%), and vitamin B12 (for 37.2%). We conclude that low SES is a risk factor for a spectrum of vitamin deficiencies. Diet quality can partially explain the socioeconomic differences in vitamin status, suggesting that policymakers can mitigate socioeconomic inequality in nutritional status through improving diet quality.

Malnutrition and Food Insecurity Might Pose a Double Burden for Older Adults

Although food insecurity has been associated with a disadvantageous socioeconomic status, especially in older adults, its association with comorbidities is less clear. The scope of the present cross-sectional study was to assess the prevalence of food insecurity among older adults and evaluate the association between food insecurity, malnutrition, chronic disease, multimorbidity and healthcare utilization. A total of 121 older adults (mean (standard deviation) age: 72.6 (8.1)) were recruited from a Primary Care Health Center from 10 August 2019 to 10 September 2019. Food insecurity and malnutrition status were assessed by the Household Food Insecurity Access Scale and Mini Nutritional Assessment tool, respectively. Recorded variables included financial, family data and comorbidities. The prevalence of food insecurity in the sample reached 50.4%, with men and older adults malnourished or at risk for malnutrition, exhibiting high risk for food insecurity. Multimorbidity, frequency of health care utilization and medication adherence were not associated with food insecurity, possibly due to the free health services and remunerated medications offered by the Greek government. However, male gender and malnutrition risk were significant predictors of food insecurity in the multiple logistic analyses. This study highlights the need for mainstreaming food insecurity assessment among older adults with comorbidities, especially those at risk for malnutrition.

New environmentally friendly bio-based micronutrient fertilizer by biosorption: From laboratory studies to the field

This paper reports the studies on the elaboration of new environmentally friendly fertilizer obtained by valorization of post-extraction biomass residues of alfalfa (Medicago) and goldenrod (Solidago), after extraction with supercritical carbon dioxide, via biosorption process. The performance and controlled release properties of fertilizer were assessed in laboratory under in vitro and in vivo conditions, as well as on the field. In vitro tests show high bioavailability of micronutrients (Cu, Mn, Zn) administered on the biological carrier - between 60 and 80%, in relation to 100% availability of sulphate microelements. This phenomenon is desirable and indicates slowed release pattern of micronutrients. Germination tests demonstrated the phytotoxicity effect of sulphates, while yield increase and biofortification effect by the use of new fertilizers was achieved. Field trials showed, that with respect to conventional micronutrient fertilizers (mineral salts), fertilizers obtained via biosorption resulted in increase of the content of Cu, Mn and Zn by 2.6, 88.6 and 50.6% in plant biomass, respectively. This is important from the point of view of plant and animal nutrition. In addition, the uptake of fertilizer components was calculated, indicating their degree of use. Calculations of micronutrient uptake in field trials shows a higher uptake of fertilizing microelements of products obtained via biosorption by 4.04% (Zn), 1.47% (Cu) and 20.63% (Mn) in relation to sulphates.

Postoperative hunger after outpatient surgery in patients anesthetized with propofol vs sevoflurane: a randomized-controlled trial

PURPOSE

Previous preclinical and preliminary clinical data suggest an appetite-stimulating effect of propofol compared with halogenated drugs. This study compared the effects of propofol with those of sevoflurane on recovery of hunger during the postoperative period.

METHODS

Patients undergoing outpatient transvaginal oocyte retrieval were randomized to propofol-remifentanil (propofol group) or sevoflurane-remifentanil (sevoflurane group) anesthesia. The primary endpoint was the time before feeling hungry (≥ 50/100 mm on a visual analogue scale). Secondary endpoints included plasma levels of ghrelin, leptin, and insulin (ten minutes, one hour, and two hours after anesthesia), caloric intake at first feed, and discharge readiness time.

RESULTS

In the 58 patients allocated to either the propofol or sevoflurane group, there was no difference in the median [interquartile range] recovery time of hunger (97 [75-138] vs 97 [80-140] min, respectively; median difference, 1; 95% confidence interval [CI], - 15 to 14; P = 0.91); caloric intake (245 [200-343] vs 260 [171-314] kcal; P = 0.39); or discharge readiness time (125 [85-153] vs 125 [95-174] min, P = 0.29). The groups showed no difference in crude plasma levels of ghrelin, leptin, and insulin at any time-point. When peptide plasma levels were expressed as a % change from baseline, there was a higher insulin plasma level one hour after anesthesia in the sevoflurane group (median difference, 4.9%; 95% CI, - 16.2 to 43.4) compared with the propofol group (median difference, - 21.2%; 95% CI, - 35.7 to 9.1; adjusted P = 0.01).

CONCLUSION

Propofol did not accelerate the recovery of hunger compared with sevoflurane after outpatient minor surgery. Moreover, propofol did not have distinguishable effects on other clinical or biological parameters associated with food intake.

TRIAL REGISTRATION

www.ClinicalTrials.gov (NCT02272166); registered 22 October, 2014.

The Challenge of Feeding the World

The aim of the present research is to provide a comprehensive review about the current challenges related to food security and hidden hunger. Issues are presented according to major factors, such as growing population, changing dietary habits, water efficiency, climate change and volatile food prices. These factors were compiled from reports of major international organizations and from relevant scientific articles on the subject. Collecting the results and presenting them in an accessible manner may provide new insight for interested parties. Accessibility of data is extremely important, since food security and its drivers form a closely interconnected but extremely complex network, which requires coordinated problem solving to resolve issues. According to the results, the demand for growing agricultural products has been partly met by increasing cultivated land in recent decades. At the same time, there is serious competition for existing agricultural areas, which further limits the extension of agricultural land in addition to the natural constraints of land availability. Agricultural production needs to expand faster than population growth without further damage to the environment. The driving force behind development is sustainable intensive farming, which means the more effective utilization of agricultural land and water resources. Current global trends in food consumption are unsustainable, analyzed in terms of either public health, environmental impacts or socio-economic costs. The growing population should strive for sustainable food consumption, as social, environmental and health impacts are very important in this respect as well. To this end, the benefits of consuming foods that are less harmful to the environment during production are also to be emphasized in the scope of consumption policy and education related to nutrition as opposed to other food types, the production of which causes a major demand for raw materials.

Food sources, energy and nutrient intakes of adults: 2013 Philippines National Nutrition Survey

BACKGROUND

Comprehensive assessment of dietary intakes of foods and nutrients in Filipino adults are lacking. This study evaluated energy and nutrient intakes and food sources of key nutrients consumed by Filipino adults.

METHODS

The participants were from the 2013 National Nutrition Survey wherein food intake of young adults aged 19-49 years (n = 12,896) and older adults aged 50 years and above (n = 7853) were collected using 24-h recalls. Usual nutrient intakes were estimated using PC-SIDE program. The Philippines Dietary Reference Intakes were used to calculate proportions of inadequate intake using Estimated Average Requirement (EAR) and Acceptable Macronutrient Distribution Ranges (AMDR). Energy adequacy was evaluated using the Institute of Medicine (IOM) equation for Estimated Energy Requirements (EER).

RESULTS

The nutrient intakes with the highest prevalence of inadequacy (> 50%) were: iron (97-99%), vitamin C (96-98%), calcium (95-98%), riboflavin (86-91%), folate (89-90%), thiamine (73-89%), energy (67-70%), total fat (55-67%), and vitamin A (54-56%). Refined rice, pork and breads contributed most to daily intakes of energy, protein, carbohydrates, thiamine, riboflavin, and iron. Low intake of vegetables, fruits and dairy was common in both age groups.

CONCLUSIONS

This study demonstrated that intakes of many nutrients were markedly inadequate among adults in the Philippines, due to the rice-dominant dietary pattern with few nutrient-dense foods. These results can be used to support the development of specific interventions to improve the shortfalls in nutrient intakes.