The repeating history of objections to the fortification of bread and alcohol: from iron filings to folic acid

Dietary intake of nutrients involved in one-carbon metabolism and risk of urothelial cell carcinoma: A prospective cohort study

Nutrients involved in one-carbon metabolism may play a role in carcinogenesis through DNA replication, repair and methylation mechanisms. Most studies on urothelial cell carcinoma (UCC) have focused on folate. We sought to examine the association between B-group vitamins and methionine intake and UCC risk, overall and by subtype, and to test whether these associations are different for population subgroups whose nutritional status may be compromised. We followed participants in the Melbourne Collaborative Cohort Study (N = 41,513) for over 20 years and observed 500 UCC cases (89% originating in the bladder; superficial: 279, invasive: 221). Energy-adjusted dietary intakes of B vitamins (B1, B2, B3, B5, B6, B8, B9 and B12) and methionine were estimated from a 121-item food frequency questionnaire administered at baseline (1990-1994), using the residuals method. We used Cox regression models to compute hazard ratios (HRs) of UCC risk per standard deviation (SD) of log-transformed nutrient intakes and 95% confidence intervals, adjusted for potential confounders. We investigated associations by tumor subtype, and tested interactions with sex, country of birth, smoking and alcohol drinking. The risk of UCC appeared not to be associated with intake of B-group vitamins or methionine, and findings were consistent across tumor subtypes and across demographic and lifestyle characteristics of the participants. A potential interaction between vitamin B1 and alcohol drinking was observed (all participants: HR per 1 SD = 0.99 (0.91-1.09), never drinkers: HR = 0.81 (0.69-0.97), p-interaction = 0.02), which needs to be confirmed by other studies. Our findings do not indicate that dietary intake of nutrients involved in one-carbon metabolism are associated with UCC risk.

Nutritional deficiencies in homeless persons with problematic drinking: a systematic review

Background

A significant proportion of homeless people drink alcohol excessively and this can lead to malnutrition and consequent medical problems. The aim of this review was to assess the evidence on the range of nutritional deficiencies in the homeless problem-drinking populations.

Methods

We conducted a comprehensive search of nine scientific literature databases and 13 grey literature sources. We included studies of any design that included homeless population with problem-drinking and reported measures of nutritional deficiencies in urine or blood. Study selection and data extraction was done by one reviewer and checked by another. Data on malnutrition profile were summarized narratively.

Results

We found nine studies reporting nutritional deficiencies in homeless populations with problem-drinking. The oldest study was from the 1950s and the most recent from 2013. The following nutrients were reported across studies: vitamins B1, B2, B6, B9, B12, C, A, and E; haemoglobin; and albumin. The most common deficiencies reported were of vitamin B1 (prevalence of deficiency was 0, 2, 6, 45, and 51% in five studies) and vitamin C (29, 84, and 95% in three studies). None of the studies were assessed to be at a low risk of bias.

Conclusions

The limited, low quality and relatively old evidence suggests that homeless people who drink heavily may be deficient in vitamin C, thiamine, and other nutrients. New, well conducted studies are needed in order to optimally inform public health interventions aimed at improving deficiencies in this population.

Trial Registration

PROSPERO CRD42015024247

Electronic supplementary material

The online version of this article (doi:10.1186/s12939-017-0564-4) contains supplementary material, which is available to authorized users.

Poor knowledge and practices related to iodine nutrition during pregnancy and lactation in Australian women: pre- and post-iodine fortification

A before-after review was undertaken to assess whether knowledge and practices related to iodine nutrition, supplementation and fortification has improved in Australian women since the introduction of mandatory iodine fortification in 2009. Surveys of pregnant (n = 139) and non-pregnant (n = 75) women in 2007–2008 are compared with surveys of pregnant (n = 147) and lactating women (n = 60) one to two years post-fortification in a regional area of New South Wales, Australia. A self-administered questionnaire was completed and dietary intake of iodine was assessed using a validated food frequency questionnaire. A generally poor knowledge about the role and sources of iodine in the diet remained after fortification. Post-fortification, iodine-containing supplements were being taken by 60% (up from 20% pre-fortification) and 45% of pregnant and lactating women, respectively. Dairy foods were the highest contributors to dietary iodine intake (57%–62%). A low intake of fish and seafood resulted in this food group contributing only 3%–8% of total intake. A low level of public awareness regarding the role of iodine in health supports the need for public health strategies in addition to fortification, such as an accompanying consumer education campaign, increased uptake of supplementation, and on-going monitoring.

Iodine fortification: why, when, what, how, and who?

PURPOSE OF REVIEW

To highlight current issues regarding the role of iodine fortification in correcting and preventing iodine deficiency. Universal salt iodization (USI) is recommended, wherein all salt is iodized; however, a more graduated approach may be warranted.

RECENT FINDINGS

Iodine deficiency is widespread and has re-emerged in countries such as Australia, New Zealand and the UK. As well as supplementation in groups such as pregnant and lactating women who have increased iodine requirements, public health strategies to improve iodine intakes include voluntary or mandatory fortification of the food supply. A key player in the process of fortification is the food industry, wherein misperceptions that the addition of iodized salt to foods alters taste and colour still persist and legislation in some countries that prohibits its addition to manufactured foods, can result in a reluctance to support USI.

SUMMARY

Ameliorating iodine deficiency on a population level in countries with mild-to-moderate deficiency is warranted. Risk of both inadequate and excess iodine intakes requires regular monitoring to accompany fortification programmes as well as strategies to address subpopulations at risk. More sensitive indicators of recent iodine status are needed to rapidly assess the impact of fortification on improving the status.