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EDITOR'S NOTE: This short paper is the inauguration address for installing Dr. Peter Walker as the first Irwin H. Rosenberg Professor of Nutrition and Human Security at Tufts University. The paper addresses the determinants of human security, of which nutrition is a large part, and the challenges that scientists face when doing research on human security issues.

Studies have reported the potential benefits of consuming conjugated linoleic acid (CLA) and ruminant trans fatty acids (R-TFAs) in reducing the risk factors of metabolic syndrome (MetS). In addition, encapsulation of CLA and R-TFAs may improve their oral delivery and further decrease the risk factors of MetS. The objectives of this review were (1) to discuss the advantages of encapsulation; (2) to compare the materials and techniques used for encapsulating CLA and R-TFAs; and (3) to review the effects of encapsulated vs non-encapsulated CLA and R-TFAs on MetS risk factors. Examination of papers citing micro- and nano-encapsulation methods used in food sciences, as well as the effects of encapsulated vs non-encapsulated CLA and R-TFAs, was conducted using the PubMed database. A total of 84 papers were examined; of these, 18 studies were selected that contained information on the effects of encapsulated CLA and R-TFAs. The 18 studies that described encapsulation of CLA or R-TFAs indicated that micro- or nano-encapsulation processes stabilized CLA and prevented oxidation. CLA was mainly encapsulated using carbohydrates or proteins. So far, oil-in-water emulsification followed by spray-drying were the frequently used techniques for encapsulation of CLA. Further, 4 studies investigated the effects of encapsulated CLA on MetS risk factors compared with non-encapsulated CLA. A limited number of studies investigated the encapsulation of R-TFAs. The effects of encapsulated CLA or R-TFAs on the risk factors for MetS remain understudied; thus, additional studies comparing the effects of encapsulated and non-encapsulated CLA or R-TFAs are needed.

Consumption of yogurt and other fermented products is associated with improved health outcomes. Although dairy consumption is included in most dietary guidelines, there have been few specific recommendations for yogurt and cultured dairy products. A qualitative systematic review was conducted to determine the effect of consumption of fermented milk products on gastrointestinal and cardiovascular health, cancer risk, weight management, diabetes and metabolic health, and bone density using PRISMA guidelines. English language papers in PubMed were searched, with no date restrictions. In total, 1057 abstracts were screened, of which 602 were excluded owing to lack of appropriate controls, potential biases, and experimental design issues. The remaining 455 papers were independently reviewed by both authors and 108 studies were included in the final review. The authors met regularly to concur, through consensus, on relevance, methods, findings, quality, and conclusions. The included studies were published between 1979 and 2017. From the 108 included studies, 76 reported a favorable outcome of fermented milks on health and 67 of these were considered to be positive or neutral quality according to the Academy of Nutrition and Dietetics’ Quality Criteria Checklist. Of the 32 remaining studies, the study outcomes were either not significant (28) or unfavorable (4), and most studies (18) were of neutral quality. A causal relationship exists between lactose digestion and tolerance and yogurt consumption, and consistent associations exist between fermented milk consumption and reduced risk of breast and colorectal cancer and type 2 diabetes, improved weight maintenance, and improved cardiovascular, bone, and gastrointestinal health. Further, an association exists between prostate cancer occurrence and dairy product consumption in general, with no difference between fermented and unfermented products. This article argues that yogurt and other fermented milk products provide favorable health outcomes beyond the milk from which these products are made and that consumption of these products should be encouraged as part of national dietary guidelines. Systematic review registration: PROSPERO registration no. CRD42017068953.

Context The presence of retail food establishments around schools can be a potentiating or protective factor for overweight in students, depending on access to these places as well as types of foods available therein. The hypothesis for this study was that a greater density and proximity of retail food establishments around schools influence the weight of students. Objective To systematically review the available observational literature on the association between retail food establishments around schools and the occurrence of overweight and obesity in schoolchildren and adolescents. Data Sources Observational studies were searched in the MEDLINE, EMBASE, and SCOPUS databases published until May 2019. Data Extraction Two independent reviewers extracted relevant data. Data Analysis Data on the 31 included studies were summarized with narrative synthesis according to meta-analyses of observational studies in epidemiology, exploring the type of food establishments around schools and analyzing qualitatively the impact of proximity or density on overweight and obesity rates. Conclusion Of the 31 articles, a direct association between proximity or density of establishments (mainly fast food restaurants, convenience stores, grocery stores) around schools and overweight and obesity in children and adolescents were found in 14 studies. However, authors of 13 papers found no association and inverse association was presented in 4 papers. The studies presented different methods of classification, location, and analysis of retail food establishments, making it difficult to conclude the real influence that the presence of these establishments near schools have on the nutritional status of children and adolescents. Therefore, future studies should consider the use of longitudinal designs and standardized analysis of the food environment around schools to better understand this food environment and its influence on health-related behaviors.

Context Periodontal disease is a chronic inflammatory gum condition that is more prevalent in older populations. The development of periodontal disease has been directly linked to inflammatory dietary habits. Objective This systematic review aimed to 1) describe the relationship and 2) describe the direction of the relationship between dietary intake (nutrients and food groups) and periodontal disease in community-dwelling, older adults. PRISMA guidelines were followed for this review. Data Sources A systematic search of the databases MEDLINE, EMBASE, Global Health, CINAHL, Science Direct, Informit, and Cochrane Library was conducted from the earliest possible date until September 2018. Search terms were related to main themes: “periodontal disease,” “gingivitis,” “gum diseases,” “dietary intake” and “older adults.” The search produced 779 records, and after additional publications were obtained and duplicates were removed, 666 publications underwent title and abstract screening. Included papers were written in English and were based on populations of healthy, older adults living in community-based settings. Nine papers met inclusion criteria and were included in this review. Data Extraction Sample size, participant characteristics, inclusion and exclusion criteria, periodontal measures, dietary measures, confounders, and results were sorted by study type, author, year, and country. Data Analysis Quality of the extracted data was analyzed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Conclusions Inverse associations were found between fatty acids, vitamin C, vitamin E, beta-carotene, fiber, calcium, dairy, fruits, and vegetables and risk of periodontal disease. Overall, this review found a relationship between poor dietary intake and increased risk of periodontal disease; however, this needs to be further explored. Systematic Review Registration PROSPERO Registration Number CRD42017065022.

Context No meta-analyses appeared to have been conducted to examine overall correlations between resonance Raman spectroscopy (RRS)–assessed skin carotenoids and plasma/serum carotenoids. Objective To review the available literature and quantify the association between RRS-assessed skin carotenoids and plasma/serum carotenoids via a meta-analysis of observational studies. Data Sources To identify relevant publications, we searched the PubMed, Embase, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, ProQuest, and Scopus databases in April 2020 for items combining 3 concepts: Raman spectroscopy, skin, and plasma or serum. Data Extraction Criteria for inclusion were publication in a peer-reviewed journal between 1990 and 2020, available in English language, and results reported as a baseline Pearson correlation coefficient. In teams of 2, the researchers independently reviewed titles and abstracts of 2212 nonduplicate papers with initial screening yielding 62 papers for full-text review, of which 15 were deemed eligible for inclusion. Data Analysis A random-effects model in R (version 4.0.0) “meta” package was used to analyze the correlation between RRS-assessed skin and plasma/serum carotenoids. A subgroup analysis was conducted for studies involving adults and children, respectively. Conclusions The 15 studies included 1155 individuals: 963 adults and 192 children. One study included children and adults. The random-effects model yielded an overall correlation of 0.68 (95%CI, 0.61–0.74; I2 = 74%; P Systematic Review Registration PROSPERO (record number 178835)

Context Poor diet quality and unhealthy dietary patterns have been linked to poor bone health, yet few studies have investigated the role of diet quality in bone health in pediatric populations. Objective This systematic review aims to assess the available evidence on the association between diet quality and bone health markers in children and adolescents. Data Sources The PubMed, Scopus, and Virtual Health Library databases were searched electronically from October to November 2022, without any restrictions on date or language. The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist was used to assess the quality of the studies. Data Extraction Published observational studies in children and adolescents (ages 2 to 19 years) that investigated the association between diet quality and bone health were eligible for inclusion. Two researchers independently analyzed and selected all articles using the Rayyan app. Initially, 965 papers were identified. A total of 12 observational studies qualified, including 8 cross-sectional and 4 longitudinal studies. The sample comprised 7130 individuals aged 3 to 17.9 years, representing both sexes. Bone health was evaluated by measures of bone mineral density and bone mineral content. Data Analysis Seven studies (58.3%) showed significant associations between diet quality and bone health markers, all of which evaluated diet quality by identifying dietary patterns. Diet quality as evaluated by all dietary indexes was not associated with bone health markers. Conclusions Adherence to a healthy diet may benefit bone health in children and adolescents. These findings emphasize the importance of developing effective public health policies that encourage healthy eating habits from childhood to preserve bone health. Longitudinal research using a specific tool to assess diet quality in relation to bone health is warranted. Future studies should also measure bone-regulating hormones and markers of bone turnover. Systematic Review Registration PROSPERO registration no. CRD42022368610.

Objective This review aims to synthesize the literature describing policy approaches to nutrition-focused food banking in industrialized countries, spanning the period 2000 to October 2021. Background The charitable food system provides food assistance to increasing numbers of people experiencing food insecurity in industrialized countries. Calls to improve the nutrition quality of foods provided by foods banks, pantries, and shelves have increased, yet little is known about the challenges faced when initiating policy in this setting. Methods A protocol based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews Guidelines was developed and registered with Open Science Framework. Four electronic databases (MEDLINE [Ovid], Global Health, ProQuest, and Scopus) were searched for peer-reviewed articles published in English. A gray literature search was conducted using Google Advanced Search. Results Of 642 peer-reviewed articles screened, 15 were eligible for inclusion. In addition, 24 gray literature documents were included. These 39 papers were assessed against the Iron Triangle of Hunger Relief and the Campbell et al framework of organizational factors. Six themes were identified: (1) there is a moral imperative to take action to ensure the provision of appropriate and nutritious food for vulnerable clients; (2) nutrition policies are unlikely to be formalized; (3) the unpredictability of donated food is a barrier to providing healthy foods; (4) reliance on donations affects the sector’s willingness to reduce the unhealthy inventory for fear of losing donors, and the challenges of managing donor relationships were emphasized; (5) organizational capacity (volunteer workforce, executive leadership support) must be considered; (6) the existing measure of success is a weight-based metric that does not support food banks’ prioritizing of healthy foods. These, and other characteristics, were incorporated into an adapted framework. Conclusion There is a need and opportunity for nutrition-focused food banking. A priority action area is the adoption of an outcome metric that is based on nutritional quality, to reorient the charitable food system.

This paper reviews developments regarding the use of plasma-free amino acid (PFAA) profiles as biomarkers for detecting and predicting disease risk. This work was initiated and first published in 2006 and was subsequently developed by Ajinomoto Co., Inc. After commercialization in 2011, PFAA-based tests were adopted in over 1500 clinics and hospitals in Japan, and numerous clinician-led studies have been performed to validate these tests. Evidence is accumulating that PFAA profiles can be used for diabetes prediction and evaluation of frailty; in particular, decreased plasma essential amino acids could contribute to the pathophysiology of severe frailty. Integration of PFAA evaluation as a biomarker and effective essential amino acid supplementation, which improves physical and mental functions in the elderly, could facilitate the development of precision nutrition, including personalized solutions. This present review provides the background for the technology as well as more recent clinical findings, and offers future possibilities regarding the implementation of precision nutrition.

This paper examines the implications of intracultural difference for the design and implementation of nutrition interventions. It raises the question of whether small-sample, mixed-method implementation research, using a focused ethnographic approach, has sufficient power to detect meaningful differences in cultural beliefs, values, perceptions, and attitudes that are important for the design and implementation of nutrition interventions. It first presents the theoretical framework that was used to guide the research, followed by a description of the methodology of the Focused Ethnographic Study for Infant and Young Child Feeding. It then uses the findings from recent research in Ghana to address the central question. The findings document strong elements of shared cultural consensus, but intracultural differences of importance, in relation to the planning and content of behavior change communication.

For more than 50 years, the United States federal government has regulated food fortification. During this time, the nutritional situation in the United States has improved greatly, whereas scientific information about the role of vitamins and minerals in human growth and development has increased exponentially. Concurrently, government authority to regulate food fortification has declined. This paper provides a brief history of U.S. food fortification policy and describes the contribution of food fortification to U.S. nutrient intakes. The paper highlights future directions of food fortification in the United States in light of these important developments, and addresses the issue of risk and the need to balance deficiency and toxicity in a generally well nourished population.

Iron supplementation, mostly with a therapeutic orientation, has been a key strategy for the short-term control of iron deficiency and ferropenic anemia. It has been used almost exclusively in antenatal clinics, but in spite of its confirmed efficacy in supervised trials, it has proven ineffective in practice in most developing countries. Poor effectiveness has been attributed to various factors including insufficient dose and time of supplementation and poor adherence. These problems have led to the administration of high iron doses, which have proven equally ineffective in practice. This paper introduces four concepts: (1) that iron supplementation targeted to pregnant women should cover the full reproductive cycle, from prepregnancy to at least the end of lactation instead of only the pregnant woman; (2) that entering pregnancy with iron deficiency contributes to the failure of antenatal iron supplementation and that prepregnancy iron reserves increase the effectiveness of antenatal supplementation; (3) that medium- to long-term weekly ingestion of proper iron-folate supplements, with a preventive aim and directed to all risk groups, should be community based rather than health service based but supervised by the latter (in this sense, preventive supplementation is equal to targeted iron fortification); and (4) that preventive supplementation, based on weekly dosing, has proven efficacious. Problem-oriented research to evaluate the sustainability and medium- to long-term efficacy of these concepts is called for. The bases for the concepts and suggestions are summarized in this paper.

Context Consumption of high-energy food has increased globally, thereby leading to an increase in many diseases. One strategy for addressing this is to make people aware of their energy intake through energy and fat labels. However, the effectiveness of this remains debatable. Objective This review aims to pool the mixed outcomes of recent studies assessing the effect of energy and fat content labeling on food consumption pattern. Data Sources Google Scholar, MEDLINE, and Cochrane Library databases were searched. Randomized controlled and quasi-experimental controlled trials published from 2014 to 2019 were included. Data Extraction Two reviewers screened 413 abstracts independently. Qualitative and quantitative data was extracted from 10 articles; meta-analysis was carried out on 6 of those studies. Results The majority of the included papers were conducted in the regions of America, the Western Pacific, and Europe. Overall, the 6 studies claimed that labeling did not reduce the consumption of energy or fat. However, meta-analysis showed that fat and energy content labeling of food had a statistically significant effect on consumption. Subgroup analysis showed no difference with respect to types of labels, ie, context labeling vs traffic-light labeling, but energy content labels seemed to be more effective than fat content labels in influencing healthy food choices. Conclusion Energy and fat content labeling were shown to reduce the consumption of each significantly. However, the outcome was influenced by the study setting and the population concerned. There is a need for research in other regions in order to assess the global effectiveness of nutrition labels on food consumption. Systematic Review Registration PROSPERO registration no. CRD42020172675.

The array of results discussed in this paper is assembled by stage of gestation in the following table (Table 1). We must allow some uncertainty for some outcomes as to the precise stages of gestation in which they originate. For instance, with obesity, the effects of famine exposure may extend beyond the first trimester into the second. Yet, the table is perhaps sufficient in itself to support the point with which the paper opened, namely, that stage of development is crucial to the appreciation of the effects of prenatal nutrition.

Context Dietary intake research has increasingly focused on improving diet quality in low- and middle-income countries (LMICs). Accompanying this is the need for sound metrics to assess diet quality. Objective This systematic literature review aims to describe existing diet quality indices for general populations and highlights recommendations for developing such indices for food system research in LMICs. Data sources Three electronic databases were searched for papers published between January 2008 and December 2017. Data extraction Articles published in English and describing the development of an index to measure overall diet quality, irrespective of whether they were for high-income countries or LMICs, were included. Data analysis Eighty-one indices were identified, over two thirds were based on national dietary guidelines from high-income countries. Of the 3 key diet quality dimensions, “diversity” was included in all 18 indices developed for LMICs, “moderation” was captured by most, and “nutrient adequacy” was included 4 times. Conclusions Indices need to be developed that include all dimensions, include foods and/or food groups rather than nutrients, use an optimal range for individual components in the score, and express the intake of healthy and unhealthy components separately. Importantly, validation of the index should be part of its development.

CONTEXT Health benefits of yogurt are well documented in adults and older children, but less is known about the effects of yogurt in infants and toddlers (aged 4 to 24 months). OBJECTIVE The aim of this qualitative systematic review was to assess the effects of yogurt and fermented milk products on the health of infants and toddlers. DATA SOURCES PubMed was searched for English-language papers. No date restrictions were applied. STUDY SELECTION Randomized controlled trials, observational studies, and prospective cohort studies were included. Systematic or narrative reviews, conference abstracts, and dissertations were excluded. In total, 1624 abstracts were screened, of which 1614 were excluded. DATA EXTRACTION Full texts of the remaining 10 abstracts were independently reviewed by both authors, who reached consensus about relevance, methods, findings, quality, and conclusions of the included studies. RESULTS The included studies (published between 1987 and 2017) were heterogeneous with respect to sample size, study population, and type of yogurt used. Five of six studies showed a positive effect of yogurt consumption on infectious diarrhea. Two studies reported a positive effect on gut microbiota composition. Two cohort studies reported a positive effect on reducing the incidence of atopic dermatitis, one of which also reported a positive impact on food sensitivity. CONCLUSIONS Published evidence, much of it decades old, supports a health benefit of yogurt consumption in infants and children. New short- and long-term studies are needed to better evaluate the impact of yogurt consumption in contemporary settings.

Context Hypothalamic inflammation and dysfunction may be induced by high-fat diets. However, the mechanisms involved in this process have not been fully elucidated. Objective To evidence, in animal models, of how a high-fat diet influence the mechanisms involved in hypothalamic inflammation. Data sources Scopus, PubMed/Medline, Web of Science, Science Direct, and Embase databases were searched. Data extraction The exclusion criteria were human studies, studies with medicinal products or other substances not related to food, paper reviews, studies that used a surgical intervention or an intervention with food to reverse hypothalamic inflammation, and studies with genetically modified animals. The identified studies were evaluated according to the following inclusion criteria: animal studies, studies in which a control group was included in the experimental design, and studies in which markers of inflammation in the hypothalamus were evaluated. Data analysis A total of 322 studies were found, of which 9 met the inclusion criteria for a systematic review, conducted in accordance with the PRISMA guidelines, and were included in this review. Conclusion The exposure of rodents to high-fat diets promoted an increase in levels of several pro-inflammatory cytokines and other proteins involved in the inflammatory process in the hypothalamus. This process was associated with increased glial cell activity.

ContextWhether dietary restraint and dieting are risk factors associated with eating disorders has not been explored in the context of pediatric weight management.ObjectiveTo review associations between dietary pediatric weight management, dietary restraint, dieting, and eating disorder risk.Data sources, selection, and extractionFour databases – MEDLINE, EMBASE, Cochrane Library, and PsycINFO – were searched to May 2020 to identify pediatric weight management interventions with a dietary component for children and adolescents with overweight or obesity. The review was limited to studies reporting dietary restraint and/or dieting at preintervention, postintervention, and/or follow-up. Screening and quality assessment were conducted in duplicate, and data extraction was completed by 1 reviewer and cross-checked for accuracy. Data extracted included study characteristics, dietary restraint/dieting, and eating disorder–related outcomes (including disordered eating, body image, self-esteem, depression, and anxiety).ResultsA total of 26 papers, representing 23 studies, were included. Of these, 20 studies reported on dietary restraint, which increased (10 postintervention, 6 follow-up) or remained unchanged (7 postintervention, 5 follow-up), and 5 studies reported on dieting, which increased (1 study), remained unchanged (2 studies) or decreased (2 studies) postintervention. All studies that reported on other eating disorder risk factors (eg, binge eating, body dissatisfaction, and depression) and weight-related outcomes found improvement or no change postintervention or at follow-up.ConclusionThe results of this review suggest that current measures of dietary restraint and dieting are not associated with eating disorder risk within the context of pediatric weight management; however, long-term data is limited. In addition, those current measures may not be suitable risk markers. Concerns about dietary restraint and dieting leading to eating disorders should not prevent access to quality care for young people with obesity.Systematic Review RegistrationPROSPERO registration no. 2017 CRD42017069488.

Context Attention deficit/hyperactivity disorder (ADHD) is a neurological disorder associated with iron dysregulation in children. Although previous focus was on examining systemic iron status, brain iron content may be a more reliable biomarker of the disorder. Objective This systematic review examines whether children with ADHD have lower serum as well as brain iron concentrations, compared with healthy control subjects (HCS). Data sources A systematic literature search was conducted in Medline via PubMed, the Cochrane Library, Web of Science, Embase. and Ovid for papers published between 2000 and June 7, 2019. Data extraction Studies were included if the mean difference of iron concentration, measured as serum iron, serum ferritin, or brain iron, between children with ADHD and HCS was an outcome measure. Data analysis Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Risks of bias within and between studies were assessed using the quality assessment tools of the National Institutes of Health. Of 599 records screened, 20 case-control studies met the inclusion criteria. In 10 of 18 studies in which serum ferritin concentration was assessed, and 2 of 10 studies that assessed serum iron, a significant difference between children with ADHD and HCS was observed. Results of systemic iron levels were inconsistent. In 3 studies in which brain iron concentration was assessed, a statistically significant, lower thalamic iron concentration was found in children with ADHD than in HCS. Conclusion The evidence, though limited, reveals that brain iron rather than systemic iron levels may be more associated with the pathophysiology of ADHD in children. Larger, longitudinal, magnetic resonance imaging studies are needed to examine any correlations of iron deficiency in specific brain regions and symptoms of ADHD.

Asthma is a chronic respiratory condition characterized by airway inflammation and hyperreactivity. Prevalence has continued to rise in recent decades as Western dietary patterns have become more pervasive. Evidence suggests that diets emphasizing the consumption of plant-based foods might protect against asthma development and improve asthma symptoms through their effects on systemic inflammation, oxidation, and microbial composition. Additionally, increased fruit and vegetable intake, reduced animal product consumption, and weight management might mediate cytokine release, free radical damage, and immune responses involved in the development and course of asthma. The specific aim of this review paper is to examine the current literature on the associations between dietary factors and asthma risk and control in children and adults. Clinical trials examining the mechanism(s) by which dietary factors influence asthma outcomes are necessary to identify the potential use of nutritional therapy in the prevention and management of asthma.

Nutrition labeling literature yields fragmented results about the effect of front-of-package (FOP) nutrition label formats on healthy food choice. Specifically, it is unclear which type of nutrition label format is effective across different shopping situations. To address this gap, the present review investigates the available nutrition labeling literature through the prism of dual-process theory, which posits that decisions are made either quickly and automatically (system 1) or slowly and deliberately (system 2). A systematically performed review of nutrition labeling literature returned 59 papers that provide findings that can be explained according to dual-process theory. The findings of these studies suggest that the effectiveness of nutrition label formats is influenced by the consumer's dominant processing system, which is a function of specific contexts and personal variables (eg, motivation, nutrition knowledge, time pressure, and depletion). Examination of reported findings through a situational processing perspective reveals that consumers might prefer different FOP nutrition label formats in different situations and can exhibit varying responses to the same label format across situations. This review offers several suggestions for policy makers and researchers to help improve current FOP nutrition label formats.

Aspartame is a synthetic dipeptide artificial sweetener, frequently used in foods, medications, and beverages, notably carbonated and powdered soft drinks. Since 1981, when aspartame was first approved by the US Food and Drug Administration, researchers have debated both its recommended safe dosage (40 mg/kg/d) and its general safety to organ systems. This review examines papers published between 2000 and 2016 on both the safe dosage and higher-than-recommended dosages and presents a concise synthesis of current trends. Data on the safe aspartame dosage are controversial, and the literature suggests there are potential side effects associated with aspartame consumption. Since aspartame consumption is on the rise, the safety of this sweetener should be revisited. Most of the literature available on the safety of aspartame is included in this review. Safety studies are based primarily on animal models, as data from human studies are limited. The existing animal studies and the limited human studies suggest that aspartame and its metabolites, whether consumed in quantities significantly higher than the recommended safe dosage or within recommended safe levels, may disrupt the oxidant/antioxidant balance, induce oxidative stress, and damage cell membrane integrity, potentially affecting a variety of cells and tissues and causing a deregulation of cellular function, ultimately leading to systemic inflammation.

Diet has become one of the top risk factors for poor health. The incidence of cardiometabolic disease in the United Sates, in Mexico, and in most countries is driven fundamentally by changes in diet quality. Weight gain has been typically framed as a problem of excess caloric intake, but, as reviewed in this paper, subtle changes in the quality of diet are associated with long-term weight gain. In order to successfully address obesity and diabetes, researchers and policy makers have to better understand how weight gain in the long term is modulated and to change the focus of research and public policy from one based on counting calories to one based on diet quality and its determinants at various levels.

Context The effect of both birth order and number of siblings on overweight and/or obesity has not been determined. Birth order and sibsize have been mathematically coupled to overweight and/or obesity, but thus far their respective effects have been estimated separately. Objective The aim of this systematic review was to evaluate the effects of both birth order and number of siblings on the risk of overweight/obesity. Data sources The electronic databases MEDLINE, Social Science, SocINDEX, PsycINFO, CINAHL Plus, and Academic Search Complete were searched systematically. Study selection Titles and abstracts of 1698 records were examined. After 1504 records were excluded, 2 authors independently assessed the full text of all remaining papers (n = 194); disagreements were resolved by discussion. Data extraction A standardized form for assessment of study quality and evidence synthesis was used to extract data from the included studies. Results Twenty studies were included in the systematic review, 14 of which were included in the meta-analysis. Meta-analyses showed that lower (vs higher) birth order and smaller (vs greater) number of siblings were associated with overweight and/or obesity, with ORs of 1.47 (95%CI, 1.12-1.93) and 1.46 (95%CI, 1.17-1.84), respectively. However, among the 9 studies that attempted to separate the effects of birth order and number of siblings in the same analysis, a higher risk of overweight/obesity was consistently found among individuals without siblings than among those with 1 or more siblings, rather than among firstborns more generally. Conclusion The results show that both lower birth order and lower number of siblings are associated with risk of overweight/obesity, which suggests that only children are at a slightly increased risk of overweight/obesity. Systematic review registration PROSPERO registration number CRD42014015135.

The increase in the number of individuals living alone has implications for nutrition and health outcomes. The aim of this review was to investigate whether there is a difference in food and nutrient intake between adults living alone and those living with others. Eight electronic databases were searched, using terms related to living alone, nutrition, food, and socioeconomic factors. Forty-one papers met the inclusion criteria, and data of interest were extracted. Results varied but suggested that, compared with persons who do not live alone, persons who live alone have a lower diversity of food intake, a lower consumption of some core foods groups (fruits, vegetables, and fish), and a higher likelihood of having an unhealthy dietary pattern. Associations between living alone and nutrient intake were unclear. Men living alone were more often observed to be at greater risk of undesirable intakes than women. The findings of this review suggest that living alone could negatively affect some aspects of food intake and contribute to the relationship between living alone and poor health outcomes, although associations could vary among socioeconomic groups. Further research is required to help to elucidate these findings.

The importance of creating healthier work environments by providing healthy foods and beverages in worksite cafeterias, in on-site vending machines, and at meetings and conferences is drawing increasing attention. Large employers, federal and state governments, and hospital systems are significant purchasers and providers of food and beverages. The American Heart Association, federal government, and other organizations have created procurement standards to guide healthy purchasing by these entities. There is a need to review how procurement standards are currently implemented, to identify important minimum criteria for evaluating health and purchasing outcomes, and to recognize significant barriers and challenges to implementation, along with success stories. The purpose of this policy paper is to describe the role of food-and-beverage environment and procurement policy standards in creating healthier worksite environments; to review recently created national model standards; to identify elements across the standards that are important to consider for incorporation into policies; and to delineate issues to address as standards are implemented across the country.

The most widely used method for estimating dietary zinc requirements is the factorial approach, in which it is assumed, in adults, that the physiological zinc requirement is the lowest intake that replaces endogenous zinc losses. Presented here are the results of two reviews: a narrative review of zinc losses from the human body and a systematic review of factors affecting zinc bioavailability in adult and elderly populations. The narrative review presents data on losses from integumental and excretory routes, obtained from 29 papers published up to April 2013. The systematic review includes a total of 87 publications describing dietary factors that impact zinc bioavailability, 30 of which examined phytate. A meta-analysis revealed an overall lowering of fractional zinc absorption by 0.14 (45% of control values) when the phytate : zinc molar ratio of the test meal or diet was greater than 15. These reviews provide a comprehensive resource for use in the setting of human dietary zinc requirements and emphasize the need for more high-quality data to improve estimates of zinc losses and gains.

Identification and management of sarcopenia are limited by lack of reliable simple approaches to assess muscle mass. The aim of this review is to identify and evaluate simple methods to quantify muscle mass/volume of adults. Using Cochrane Review methodology, Medline (1946-2012), Embase (1974-2012), Web of Science (1898-2012), PubMed, and the Cochrane Library (to 08/2012) were searched for publications that included prediction equations (from anthropometric measurements) to estimate muscle mass by magnetic resonance imaging (MRI) in adults. Of 257 papers identified from primary search terms, 12 studies met the inclusion criteria. Most studies (n = 10) assessed only regional/limb muscle mass/volume. Many studies (n = 9) assessed limb circumference adjusted for skinfold thickness, which limits their practical applications. Only two included validation in separate subject-samples, and two reported relationships between whole-body MRI-measured muscle mass and anthropometry beyond linear correlations. In conclusion, one simple prediction equation shows promise, but it has not been validated in a separate population with different investigators. Furthermore, it did not incorporate widely available trunk/limb girths, which have offered valuable prediction of body composition in other studies.

In the late 1980s, Professor Jean Golding at the University of Bristol in England conceived the idea of a birth cohort in Bristol and its surrounding area, to investigate the ways whereby genes and the environment interact to affect the health, behavior, and development of children. It had the novel features of recruitment prior to birth of the cohort members and collection of all available biological samples at frequent intervals, referred to as the “collect all” approach. Titled the “Avon Longitudinal Study of Parents and Children” or ALSPAC, the study began recruitment in 1991 of all willing pregnant women as early in pregnancy as possible in Bristol and surrounding health districts. By 1992, there were more than 14 000 pregnant women in the study. From the outset, it was recognized that dietary intake and the nutritional status of both the mother and the infant might be important considerations for many of the health conditions that could be examined in the study. Dietary assessment was, therefore, included at many of the time points. The first of these was in pregnancy, followed by a number of assessments during infancy and childhood, the last being at the age of 13 years. There is a wide range of dietary assessment methods which could be used in a study of this type and these vary widely in the extent of the detail obtained, but also in the cost of producing the final data from the food intakes recorded. The methods used in the ALSPAC at the various time points were those that were feasible for the numbers and group being studied and the level of funding available. Unlike some studies, the dietary data in the ALSPAC has been used for analyses for a multitude of conditions and published widely; the first dietary papers appeared in 1997. …

The postnatal feeding practices of obese and overweight mothers may place their children at particular risk for the development of obesity through shared biology and family environments. This paper reviews the feeding practices of obese mothers, describes potential mechanisms linking maternal feeding behaviors to child obesity risk, and highlights potential avenues for intervention. This review documents that supporting breastfeeding, improving the food choices of obese women, and encouraging the development of feeding styles that are responsive to hunger and satiety cues are important for improving the quality of the eating environment and preventing the intergenerational transmission of obesity.

The purpose of this paper is to succinctly review the origin of US dietary surveys, the challenges and limitations of obtaining dietary intake data, the National Nutrition Monitoring and Related Research Act of 1990, the integrated US federal food survey, and the development of the US Department of Agriculture's (USDA) automated multiple-pass method. The USDA has monitored the food consumption patterns of Americans since the late 1890 s. In 2002, the US Department of Health and Human Services and the USDA integrated their data collection efforts, with data now collected on a continuous basis. Two 24-hour dietary recalls are obtained using USDA's automated multiple-pass method. By combining their respective areas of expertise, the USDA and the Department of Health and Human Services have increased research opportunities for scientists and provided data foundational for establishing programs and public policy.

This review considers the potential of certain dietary supplements, including garlic, Ginkgo biloba, ginger, ginseng, fish oil, and vitamin E, to interfere with hemostasis. Dietary supplements are common components of the diet in the United States, with about half the US adult population taking some type of dietary supplement regularly. It has been suggested that some supplements could adversely affect coagulation when taken alone or in combination with antiplatelet medications. Supplements could alter hemostasis by a variety of mechanisms, such as reducing platelet aggregation or inhibiting arachidonic acid, a cellular signaling messenger and inflammatory intermediate. To conduct this review, multiple databases were searched using a variety of search terms to ensure relevant papers were located. Moderate to severe adverse events, such as spinal epidural hematoma, spontaneous intracerebral hemorrhage, retrobulbar hemorrhage, subarachnoid hemorrhage, spontaneous hyphema, and postoperative bleeding, have occasionally been anecdotally associated with consumption of dietary supplements. However, the number of controlled studies in the literature is too limited to demonstrate consistent anticoagulant effects of dietary supplements alone or in combination with drug therapy.

The aim of the present review was to examine the existing literature on the effectiveness of economic incentives for producing sound nutritional behavior in schools. Studies published in the English-language literature that included baseline and/or outcome data regarding food and beverage intake of schoolchildren were eligible for inclusion. A systematic search of the literature was conducted to identify relevant primary studies and relevant systematic reviews of primary studies. Altogether, 3,472 research publications were identified in the systematic search, of which 50 papers were retrieved. Of these, 30 publications representing 28 studies fulfilled the criteria for inclusion. The studies addressing price incentives suggest that such incentives are effective for altering consumption in the school setting. Other types of economic incentives have been included in combined intervention schemes, but the inclusion of other intervention elements makes it difficult to draw conclusions about the effectiveness of the economic incentive instruments per se in these studies.

There has been considerable confusion relating to the basis for changes in brain function as we age. Is there an intrinsic aging process related to some biological deterioration of cellular integrity or connectivity within the brain? If brain aging occurs, how is it related to the major problems of dementia and Alzheimer's disease (AD)? Can we affect these processes by changes in our environment, diet, and physical activity, or by ensuring we continue to engage in demanding mental topics when we are older? This was the subject of the Marabou Trust meeting in 2009, attended by over 40 international experts. The meeting benefited from nine formal lectures, which are the basis for the papers in this symposium, together with a series of mini presentations and over 6 hours of interactive debate, all of which is summarized in the accompanying attributed discussion. Brain aging is characterized by the progressive and gradual accumulation over time of detrimental changes in structure and function. These changes increase the risk of dementia, which is a clinical syndrome involving multiple cognitive deficits that become severe enough to impair the affected person's ability to function effectively in either a social or professional manner.1 The two most common causes are AD and vascular dementia, but the two conditions interact and have synergistic effects on mental impairment in many individuals. The first issue is how best to assess brain aging. Should the focus be on a detailed series of functional tests in humans, an analysis of the anatomical and biochemical/physiological processing in the brain, or clinical studies of individuals affected by different diseases or perhaps by genetic abnormalities of neural function? Presumably, a comparative biological perspective on what happens in other animals and organisms might also help elucidate the possible intrinsic features of aging. In both experimental animals …

Inflammatory bowel diseases (IBD) arise from multiple causes, including environmental factors, gut microflora, immunity, and genetic predispositions. In the course of IBD, immune homeostasis and intestinal mucosa barrier integrity are impaired. Among natural preventive treatments that have been identified to date, polyphenols appear as promising candidates. They have been shown to protect against several diseases, including cardiovascular diseases and cancers, and they have anti-inflammatory properties in non-intestinal models. This paper will review the literature that has described to date some effects of polyphenols on intestinal inflammation. Studies, conducted using in vivo and in vitro models, provide evidence that pure polyphenolic compounds and natural polyphenolic plant extracts can modulate intestinal inflammation.

The cost to developing countries, for current and future generations, of not eradicating hunger and poverty - in terms of recurrent conflicts and emergencies, widening inequalities, depleted resources, ill health, and premature death - is enormous. Although strategies are underway to address certain problems in Africa and the Middle East, much remains to be done. Breaking the poverty cycle in these regions demands both local and international attention. Nutrition transition is a key factor, since many countries in the region also suffer the consequences of the excessive and unbalanced diets that are typical of developed countries. This paper reviews the experiences with facing malnutrition in Sub-Saharan and North Africa and the Middle East.

Free radicals generated as byproducts of normal metabolism can damage biologically relevant molecules. When their generation is increased, damage can also be increased, resulting in the development of many pathological conditions. Antioxidant defenses protect the body from the detrimental effects of free radicals. Dietary fruits and vegetables provide a reasonable amount of compounds that act as physiological antioxidants. Although existing knowledge does not allow a final and conclusive assessment of the relevance of antioxidants for health, it does provide the basis for its rational consideration. This paper addresses the specific aspects of antioxidant supplementation in health and disease. Fil: Herrera, Emilio A.. Universidad San Pablo; España Fil: Jiménez, Rafael. Universidad de Salamanca; España Fil: Aruoma, Okezie I.. Touro College of Pharmacy New York; Estados Unidos Fil: Hercberg, Serge. Université Paris Sud; Francia Fil: Sánchez García, Isidro. Consejo Superior de Investigaciones Científicas; España. Universidad de Salamanca; España Fil: Fraga, César Guillermo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. University of California; Estados Unidos

This paper presents the results of a study that aimed to describe the prevalence and evolution of metabolic syndrome (MetS) in the Mediterranean population of Catalonia, Spain, between 1992―1993 and 2002-2003 by applying the National Cholesterol Education Program's Adult Treatment Panel III (ATPIII) and International Diabetes Federation (IDF) definitions. Data from two cross-sectional population-based surveys were used (ENCAT 1992―1993 [n = 820] and 2002-2003 [n = 1,384]). Applying IDF definitions, MetS tended to increase (P = 0.08), from 25% in 1992―1993 to 28.5% in 2002-2003. Applying ATPIII definitions, MetS prevalence was lower, and it increased significantly (P < 0.001) from 18.4% in 1992―1993 to 24.8% in 2002-2003. MetS prevalence is high and has increased significantly in the last decade in Catalonia.

International organizations have raised awareness of the increasing prevalence of overweight and obesity worldwide and the impact on morbidity, mortality, quality of life, and cost of healthcare. The development and implementation of obesity prevention strategies requires the identification and understanding of determinant factors that can be influenced by effective large-scale action plans over time. Strategies aimed at the primary prevention of obesity in a population should be multifaceted and designed to actively involve stakeholders and other major parties concerned; in addition, multiple settings for implementation should be considered. In this paper, an overview is presented of the strategies currently in place for obesity prevention, particularly in Spain.

This paper presents some of the most commonly utilized indicators to assess food and nutritional status. With respect to the indicators reflecting food access, those addressing poverty as well as food consumption are included. In addition, a variety of serum biochemical measures for the estimation of iron nutritional status and anemia are discussed; it is recommended that some of these be adjusted to account for sex, age, physiological status, and altitude above sea level.

This paper presents three different hunger indicators and outlines how they can be used to assess the extent of food insecurity in population groups globally and within countries at community, regional, or other subnational levels. Hunger refers to the supply, access, consumption, and intake of food at levels that are insufficient to fulfill human requirements. If the requirements are not met through the adequate absorption and use of essential nutrients, food deprivation and undernutrition occur.

Famine is a nasty turn of events that intrudes on the world's consciousness from time to time. Pictures of starving people and acutely malnourished children, rampant disease, a rising death toll, and massive suffering in some far-off land move many among us to contribute to famine relief, shocked by the paradox of famine in a world "awash in grain". Those who think about it appreciate that famine is related to poverty, that it is often triggered by climatic instability, and that it is both an instrument and tragic by-product of political conflict. But few know very much about famine beyond such fleeting insights. Even fewer are aware that the collective response to famine is woefully deficient. Just as we in the nutrition community had to fight long and hard to get malnutrition onto the development agenda as an explicit concern of public policy, so we and others like us are going to have to labor hard again to do the same for famine. This paper is an attempt to crystallize the issues involved.

As chronic, noncommunicable diseases (NCDs) have emerged as leading causes of morbidity and mortality worldwide, the World Health Organization's INTERHEALTH Programme, an international collaboration currently involving 15 countries, has focused its attention on population-based NCD prevention. Participating nations include Australia, Chile, China, Cuba, Cyprus, Finland, Japan, Lithuania, Malta, Mauritius, Russia, Sri Lanka, Tanzania, Thailand, and the United States. This paper will review and assess global trends in food and nutrient intake among INTERHEALTH countries between 1954 and 1986.

Editor's Note: This paper is one of the first suggesting that idiapathic osteoporosis may be n disorder of calcium metabolism for which increased intakes calcium mas be preventative.

This paper examines the treatment of obesity, using a feedback model of nutrient regulation. A feedback model contains afferent signals and a central controller that transduces afferent information into efferent signals that modulate the controlled system. Using this model and the receptor hypothesis for drug action, a variety of current and potential therapeutic approaches are discussed. Among the more promising approaches would be cholecystokinin agonists, small molecules that mimic ketoacids, agonists to corticotropin-releasing hormone, beta-3 agonists, antagonists to opioid peptides, antagonists to neuropeptide Y, glucocorticoid receptor antagonists, and growth hormone agonists. Since a number of mechanisms can influence body fat and nutrient partitioning, it is likely that optimal therapy will involve use of more than one pharmacologic agent.

The measurement of body composition and related metabolic parameters has become an important issue in clinical nutrition. Numerous techniques to assess visceral fat, which is strongly associated with metabolic disorders, have been developed. Other techniques focus mainly on the measurement of specific body components related to metabolic disturbances. This paper reviews methods that directly assess body composition and associated metabolic parameters. The principles of these methods and their accuracy, reproducibility, and safety, as well as the clinical implications of their use, are discussed. Recent studies have documented the safety and efficacy of radiologic methods of assessing visceral fat, muscle mass, and morphology to obtain body composition data related to metabolic disturbances. Because these techniques have been documented to be safe and effective, clinicians should consider using them in the evaluation and follow-up of patients with various conditions.

Ancient associations between emotional state and food consumption continue to be of interest at the present time. The connections between the two have increasingly been recognized to be of relevance to the field of psychiatry. This is in part a result of the need i3 understand and treat effectively the growing population of patients presenting to clinicians with eating disorders, affective disorders or both, and in part a result of an eruption of knowledge over the last several years in the neurophysiology and psychobiology of brain function and dysfunction. Even though there is still much to be explored, it has become apparent from clinical and experimental research that there is indeed a relationship between eating and mood in many and, perhaps, all people. In this paper, these associations are explored by reviewing data derived from patients in whom eating and/or mood functions are disturbed, i.e., those with an eating disorder, an affective disorder or both.

The goals of agricultural production have traditionally been to try to accommodate needs for: 1) adequate and reliable yields to provide a sufficient food supply in a growing world; 2) food safety; 3) taste; 4) convenience; 5) profit; and 6) variety. Alternative strategies to enhance any of these outcomes are typically evaluated as to their probable effects on the key outcome: yield. However, with the burgeoning consumer interest in foods that optimize health, attention is shifting from concerns over quantity alone to concerns over the constituents of foods that may promote health, and thus to the agricultural practices that will protect, and perhaps enhance these constituents of the food supply. This shift in focus requires new thinking and new strategies across all segments of the food production system. This paper summarizes selected aspects of crop production that are pivotal to the nutrient value of foods for human consumption and suggests some strategies for establishing a new research and production paradigm that will embrace nutrient quality among the priorities of agricultural research.