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Objective: To use Multi-Criteria Decision Analysis (MCDA) to determine weights for eleven criteria in order to prioritize COVID-19 non-critical patients for admission to hospital in healthcare settings with limited resources. Methods: The MCDA was applied in two main steps: specification of criteria for prioritizing COVID-19 patients (and levels within each criterion); and determination of weights for the criteria based on experts’ knowledge and experience in managing COVID-19 patients, via an online survey. Criteria were selected based on available COVID-19 evidence with a focus on low- and middle-income countries (LMICs). Results: The most important criteria (mean weights, summing to 100%) are: PaO2 (16.3%); peripheral O2 saturation (15.9%); chest X-ray (14.1%); Modified Early Warning Score-MEWS (11.4%); respiratory rate (9.5%); comorbidities (6.5%); living with vulnerable people (6.4%); body mass index (5.6%); duration of symptoms before hospital evaluation (5.4%); CRP (5.1%); and age (3.8%). Conclusions: At the beginning of a new pandemic, when evidence for disease predictors is limited or unavailable and effective national contingency plans are difficult to establish, the MCDA prioritization model could play a pivotal role in improving the response of health systems.

Importance: A paradoxical increase of growth hormone (GH) following oral glucose load has been described in ∼30% of patients with acromegaly and has been related to the ectopic expression of the glucose-dependent insulinotropic polypeptide (GIP) receptor (GIPR) in somatotropinomas. Recently, we identified germline pathogenic variants and somatic loss of heterozygosity of lysine demethylase 1A (KDM1A) in patients with GIP-dependent primary bilateral macronodular adrenal hyperplasia with Cushing's syndrome. The ectopic expression of GIPR in both adrenal and pituitary lesions suggests a common molecular mechanism., Objective: We aimed to analyze KDM1A gene sequence and KDM1A and GIPR expressions in somatotroph pituitary adenomas., Settings: We conducted a cohort study at university hospitals in France and in Italy. We collected pituitary adenoma specimens from acromegalic patients who had undergone pituitary surgery. We performed targeted exome sequencing (gene panel analysis) and array-comparative genomic hybridization on somatic DNA derived from adenomas and performed droplet digital PCR on adenoma samples to quantify KDM1A and GIPR expressions., Results: One hundred and forty-six patients with sporadic acromegaly were studied; 72.6% presented unsuppressed classical GH response, whereas 27.4% displayed a paradoxical rise in GH after oral glucose load. We did not identify any pathogenic variant in the KDM1A gene in the adenomas of these patients. However, we identified a recurrent 1p deletion encompassing the KDM1A locus in 29 adenomas and observed a higher prevalence of paradoxical GH rise (P = .0166), lower KDM1A expression (4.47 ± 2.49 vs 8.56 ± 5.62, P < .0001), and higher GIPR expression (1.09 ± 0.92 vs 0.43 ± 0.51, P = .0012) in adenomas from patients with KDM1A haploinsufficiency compared with those with 2 KDM1A copies., Conclusions and Relevance: Unlike in GIP-dependent primary bilateral macronodular adrenal hyperplasia, KDM1A genetic variations are not the cause of GIPR expression in somatotroph pituitary adenomas. Recurrent KDM1A haploinsufficiency, more frequently observed in GIPR-expressing adenomas, could be responsible for decreased KDM1A function resulting in transcriptional derepression on the GIPR locus., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Endocrinology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: Somatostatin receptor ligands have come to play a pivotal role in the treatment of both ACTH- and GH-secreting pituitary adenomas. Clinical efficacy averages 30-50%, thus a considerable number of patients with Cushing's disease or acromegaly remain unresponsive to this therapeutic approach. HTL0030310 is a new somatostatin receptor ligand selective for subtype 5 over subtype 2, thus with a different receptor profile compared to clinical somatostatin receptor ligands., Design: Assessment of the effect of HTL0030310 on hormone secretion in human ACTH- and GH-secreting pituitary adenomas in vitro., Methods: Primary cultures from 3 ACTH-secreting and 5 GH-secreting pituitary adenomas were treated with 1, 10 and 100 nM HTL0030310 alone or with 10 nM CRH or GHRH, respectively. Parallel incubations with 10 nM pasireotide were also carried out. ACTH and GH secretion were assessed after 4 and 24 hour incubation; SSTR2, SSTR3, SSTR5, GH and POMC expression were evaluated after 24 hours., Results: HTL0030310 reduced unchallenged ACTH and POMC levels up to 50% in 2 ACTH-secreting adenomas and blunted CRH-stimulated ACTH/POMC by 20-70% in all 3 specimens. A reduction in spontaneous GH secretion was observed in 4 GH-secreting adenomas and in 2 specimens during GHRH co-incubation. SSTRs expression was detected in all specimens., Conclusions: This first study on a novel somatostatin receptor 5-preferring ligand indicates that HTL0030310 can inhibit hormonal secretion in human ACTH- and GH-secreting pituitary adenomas. These findings suggest a potential new avenue for somatostatin ligands in the treatment of Cushing's disease and acromegaly., Competing Interests: Conflict of interest: The following authors are employees for Sosei Heptares: C.P.M., E.S., D.H., A.G., K.A.B., A.J.H.B., and M.B. D.R., S.A., G.O., M.B., D.F., M.P.T., M.L., G.L., C.S., and F.P.G. have no conflicts of interest to declare., (© The Author(s) 2023. Published by Oxford University Press on behalf of European Society of Endocrinology.)

Public policies often aim to improve welfare, economic injustice and reduce inequality, particularly in the social protection, labour, health and education sectors. While these policies frequently operate in silos, the education sphere can operate as a cross-sectoral link. Schools represent a unique locus, with globally hundreds of millions of children attending class every day. A high-profile policy example is school feeding, with over 400 million students worldwide receiving meals in schools. The benefits of harmonising interventions across sectors with a common delivery platform include economies of scale. Moreover, economic evaluation frameworks commonly used to assess policies rarely account for impact across sectors besides their primary intent. For example, school meals are often evaluated for their impact on nutrition, but they also have educational benefits, including increasing attendance and learning and incorporating smallholder farmers into corporate value chains. To address these gaps, we propose the introduction of a comprehensive value-for-money framework for investments toward school systems that acknowledges the return to a common delivery platform-schools-and the multisectoral returns (eg, education, health and nutrition, labour, social protection) emerging from the rollout of school-based programmes. Directly building on benefit-cost analysis methods, this framework could help identify interventions that yield the highest gains in human capital per budget expenditure, with direct implications for finance ministries. Given the detrimental impact of COVID-19 on schoolchildren and human capital, it is urgent to build back stronger and more sustainable welfare systems., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

In ASEAN countries, small freshwater fish species contribute to the nutritional needs of people with few livelihoods by providing them with significant amounts of protein, fat, vitamins and minerals. Some species are eaten whole (with their organs, skin, bones, head and eyes). To estimate the vitamin A content of these foods, conventional saponification has been applied but has not been able to fully release the retinol. Our objective was to optimise the conditions of vitamin A saponification in whole fish to have a reliable estimate of their contribution to intakes. The effects of temperature and saponification time on the retinol quantification of whole fish were evaluated using a two-factor experimental design. Reaction time had a significant effect on the saponification of standard retinyl palmitate and whole fish (p≤0.05). For whole fish, the best conditions for the saponification were to heat the samples to 80 °C for 43 minutes. Under these conditions, the retinol is well liberated from the matrix and protected from degradation and isomerisation reactions. The time-temperature couple used is more intense than that recommended for quantifying vitamin A in milk or enriched margarines. The protective effect of the food matrix against the release of retinol is evident. Vitamin A 2 alcohol (3,4-didehydroretinol) was detected in five species and the overall vitamin A contents ranged from 9.6 to 737.5 μg RE/100 g in species frequently consumed in Cambodia. The two species of small fish consumed whole were the ones that contained significantly more vitamin A among the ten tested (p≤0.05). Highlights: Vitamin A 2 alcohol was quantified in five fish species. The official saponification partially released retinol in whole fish. The optimised reaction required heating the sample to 80 °C for 43 min.

The potential of drying to preserve the nutritional quality of a small freshwater fish Henicorhynchus siamensis was assessed. Drying time to reach moisture content and water activity of 10 g/100g and 0.65 ranged from 55 h at 50 °C to 20 h at 80 °C, respectively. Dried fish powder is rich in macronutrients (protein, lipid and ash) and essential minerals (calcium, phosphorus, iron and zinc) due to water removal and despite lipid loss. It is still rich in polyunsaturated fatty acids although docosahexaenoic acid was reduced except at 60°C. Vitamin A was rapidly degraded and manganese was concentrated at high level. However, mean score for the nutritional adequacy of the 15 nutrients (SAIN) and score of nutrients to limit (LIM) show that the fish powder can be used as a food ingredient for example in the formulation of fish snack or instant soup. With the abundance of Henicorhynchus siamensis , dried fish powder from this species could contribute to food security in Cambodia, especially vulnerable people in rural areas., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

This review paper gives an insight into the effective delivery mechanisms for health-promoting substances and highlights the challenges of using antioxidants and bioactives in foods. The selection criteria for choosing bioactives and their extraction in bioavailable form with their adequate incorporation techniques and delivery mechanisms are covered. Moreover, an overview of existing methods for determination of bioactivity is given. The importance of scientifically evaluating the effects of foods or food components on consumer health before making claims about the healthiness is aligned. Finally, a scientific perspective on how to respond to the booming demand for health-promoting products is given, and we acknowledge that despite the work done, there are still many challenges that need to be overcome.

Crude palm oil (CPO) is extracted from the mesocarp of oil palm (Elaeis guineensis) fruits. CPO is widely consumed in many African countries. Due to its high provitamin A carotenoid content, it is also widely used in programmes designed to prevent vitamin A deficiency. Elaeis guineensis occurs naturally across a wide geographical range in Africa. We investigated the carotene, tocochromanol (vitamin E) and fatty acid composition of a large set of genotypes representative of this genetic and geographic diversity. We found considerable intraspecific diversity in most lipid traits. Populations from Côte d'Ivoire were distinguished from other origins by their very low palmitate content and high tocochromanol content. Genotypes from Benin, Côte d'Ivoire and Nigeria were characterized by high carotene contents. Finally, hybrids of crosses between genotypes from Côte d'Ivoire and Nigeria produce CPO with exceptionally high provitamin A and vitamin E contents together with low palmitate content., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Vegetables rich in vitamin K consumption could prevent bleeding and maintain bone status. The aims of the present work were to investigate i) the effect of household cooking (i.e., boiling for 5 min at 100 °C in distilled water and stir-frying for 3 min at 180 °C in hot canola oil) on phylloquinone bioaccessibility of five rich phylloquinone leafy vegetables, namely Water spinach (Ipomoea aquatic Forssk), Amaranth (Amaranthus blitum subsp. oleraceus L.), Chinese broccoli (Brassica alboglabra) , Pak choi (Brassica rapa L.) and Drumstick (Moringa oleifera Lam.), and ii) the structural changes of these leaves before and after in vitro gastro-intestinal digestion. All the experiments were realized in triplicate for each vegetable. The amounts of phylloquinone in leafy vegetables were noticeable in almost all species and ranged from 94 to 182 μg/100 g DM. Their cell wall polysaccharide contents greatly varied from 4.3 to 8.4 g for 100 g. The content in bioaccessible phylloquinone was low in raw leaves (<25 μg/100 g DM) as well as its bioaccessibility (<15%). Leaf pectin content impaired phylloquinone bioaccessibility using principal component analysis. Boiling and stir-frying significantly improved the bioaccessibility of phylloquinone in leaves by a factor of three to twelve and two to seven respectively (p<0.05). These variations were associated with changes in leaf structure. Palisade and spongy cells appeared ruptured and disorganized after stir-frying. Given the estimated bioaccessibility of phylloquinones, the consumption of 500 g of cooked wet leaves per day would cover phylloquinone needs of an individual adult average body weight.

Flour fortification with folic acid (FA) is implemented in many countries, and the fortification of flour with vitamin B12 has been planned. However, vitamins losses can occur during storage. In this study, fortified wheat flour was packaged either in paper bags or multilayer aluminum/PET bags, and stored in controlled conditions of temperature (25 °C or 40 °C) and relative humidity (65% or 85% RH) for 6 months. FA content, cyanocobalamin content, and microbial quality were regularly assessed. In flours packed in multilayer bags (non-permeable to oxygen and humidity), no significant FA and cyanocobalamin losses were observed, irrespective of temperature and RH. In flours packed in permeable paper bags, the microbial quality deteriorated in flours stored at 85% RH, FA loss reached 22-53% after 6 months at 85% RH, whereas cyanocobalamin loss reached 49-63% after 6 months at 65% RH. This shows that, depending on environmental conditions, packaging choice is of critical importance., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors state that there was no conflict of interest during this study, and that they were not directly or indirectly affiliated to any profit-making units that may result in a conflict of interest. Arnaud Laillou is a UNICEF staff member, but the opinions and statements in this article are those of the authors and may not reflect the official UNICEF policies., (© 2019 Published by Elsevier Ltd.)

Micronutrient deficiencies result in irreversible physical and cognitive consequences. Fortification of flour is widely applied to address micronutrient deficiencies, but vitamin losses can occur during the storage of fortified products. This work aimed at assessing the combined influence of different factors on vitamin A retention and the oxidative status of wheat flours: storage duration (up to 6months), temperature during storage, relative humidity within storage facilities, type of packaging (oxygen-permeable or not), and premix composition (with or without ferrous sulphate). Vitamin A degradation was high and occurred rapidly: more than 45% was lost within 3months in the mildest conditions, whereas over 85% was lost within 3months in the most severe conditions. Vitamin A retention was related to the extent of oxidation reactions that occurred in flours during storage, and the factors that mostly affected vitamin A retention were the storage duration, the type of packaging and the temperature., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Micronutrient deficiencies are still a public health issue in least developed countries. Promoting diet diversification is a promising strategy. Numerous fruits and vegetables are rich in micronutrients, but some of these compounds are poorly bioaccessible. The objective of this study was to identify the biochemical determinants of the micronutrient bioaccessibility in leaves. The contents in cell walls, pectins, tannins, and proteins of the leafy vegetables were assessed, and correlations with the micronutrient bioaccessibitity were explored. The leafy vegetables have interesting nutritional profiles with noticeable amounts in protein, provitamin A (β-carotene), and α-tocopherol for some species. Their cell wall contents greatly varied from 3.4 to 8.7 g/100 g as well as their pectin percentages. Only the perilla and drumstick leaves contained condensed tannins. In fresh leaves, the contents in bioaccessible carotenoids were low. The correlation study highlighted that the carotenoid bioaccessibility was negatively correlated to the pectin contents of the leaves.

Lactic acid bacteria (LAB) synthesize a wide variety of biochemical compounds during food fermentation. Carotenoids provide important biological functions for bacteria, and their consumption by humans has many beneficial effects. In this study, the presence of several genes involved in the production of carotenoids was determined by BLAST analysis and PCR in a collection of 156 LAB isolated from traditional amylaceous African fermented foods. Only the crtE gene and the crtNM operon were present and detected in Lactobacillaceae. Most of the strains with positive PCR detection of the operon crtNM produced carotenoid-like compounds when grown in MRS broth. The carotenoids produced differed from compounds previously identified in other LAB except for one peak, which was closely related to 4,4'-diaponeurosporene already reported in the literature in Lactobacillus plantarum species. Most producing strains belonged to Lactobacillus fermentum and L. plantarum species but a few Pediococcus acidilactici were also producers. Furthermore, the most efficient L. plantarum was able to synthesize carotenoids in a cereal fermented food. Genetic screening was shown to be efficient since, in all cases, it eliminated the need for biochemical analysis of strains in which no amplicons of the operon crtNM were obtained., (Copyright © 2016 Elsevier GmbH. All rights reserved.)

Food fortification is implemented to address vitamins A and D deficiencies in numerous countries. The stability of vitamins A and D3 was assessed during a two-month period reproducing the usual oil storage conditions before sale to consumers. Soybean oils with different oxidative status and vitamin E contents were stored in the dark, semi-dark, or exposed to natural light. Lipid peroxidation took place after 3 weeks of storage in dark conditions. After 2 months, the vitamin A and D3 losses reached 60-68% and 61-68%, respectively, for oils exposed to natural light, and 32-39% and 24-44% in semi-dark conditions. The determining factors of vitamin A and D3 losses were (in decreasing order) the storage time, the exposure to light and the oxidative status of the oil, whereas vitamin E content had a protective role. Improving these parameters is thus essential to make vitamins A and D fortification in oils more efficient., (Copyright © 2015. Published by Elsevier Ltd.)

Background: Hypertension is the leading cause of death in developed countries and reduction of salt intake is recommended as a key preventive measure., Objective: To assess the dietary sodium and potassium intakes in a national sample of Italian children and adolescents and to examine their relationships with BMI and blood pressure (BP) in the framework of the MINISAL survey, a program supported by the Italian Ministry of Health., Population and Methods: The study population included 1424 healthy subjects (766 boys, 658 girls) aged 6-18 years (mean age: 10.1±2.9) who were consecutively recruited in participating National Health Service centers in 10 Italian regions. Electrolyte intake was estimated from 24 hour urine collections tested for completeness by the concomitant measurement of creatinine content. Anthropometric indices and BP were measured with standardized procedures., Results: The average estimated sodium intake was 129 mmol (7.4 g of salt) per day among boys and 117 mmol (6.7 g of salt) among girls. Ninety-three percent of the boys and 89% of the girls had a consumption higher than the recommended age-specific standard dietary target. The estimated average daily potassium intakes were 39 mmol (1.53 g) and 36 mmol (1.40 g), respectively, over 96% of the boys and 98% of the girls having a potassium intake lower than the recommended adequate intake. The mean sodium/potassium ratio was similar among boys and girls (3.5 and 3.4, respectively) and over 3-fold greater than the desirable level. Sodium intake was directly related to age, body mass and BP in the whole population., Conclusions: The Italian pediatric population is characterized by excessive sodium and deficient potassium intake. These data suggest that future campaigns should focus on children and adolescents as a major target in the framework of a population strategy of cardiovascular prevention.

Background: Simple-to-use quantitative methods are needed to check the adequacy of vitamin A fortification levels., Objective: To assess the capacity of a portable fluorometer (iCheck FLUORO) and its test kit vials (iEx Mila) to quantify retinyl palmitate in fortified milks, flours (wheat, maize), and sugar., Methods: The portable fluorometer was assessed in a three-step procedure to determine its working range and linearity, intra-assay precision, and interperson precision. Measurements were compared with the results obtained by high-performance liquid chromatography (HPLC), commonly regarded as the standard method for vitamin A analysis., Results: The portable fluorometer (iCheck FLUORO) and its test kit vials (iEx Mila) precisely determined the vitamin A contents in fortifed flours, sugar, and milks. Its working range was 1 to 10, 0.5 to 3.0, and 5 to 15 mg retinol equivalents (RE) kg(-1) for flours (wheat and corn), milks, and sugar, respectively; these values are in accordance with the World Health Organization recommendations for food fortification in least developed countries. The limits of detection are higher than those of HPLC but are all satisfactory (< 1.46 mg RE kg(-1)). The coefficients of variation within and between observers were satisfactory, especially for sugar and milk., Conclusions: The linear relationship between the data from the portable fluorometer and the HPLC data confirms that the portable fluorometer provides a good determination of the vitamin A content of the fortified products in the tested range.

Over the last decades, oxidative stress has been described as a deleterious phenomenon contributing to numerous noncommunicable diseases such as cardiovascular disease, diabetes, and cancers. As many authors ascribed the healthy effect of fruit and vegetable consumption mainly to their antioxidant contents, it has been hypothesized that their protection could occur from the gut. Therefore, the aim of this study was to develop an original and physiological model of nanoemulsions to study lipid peroxidation within the intestine and to assess the properties of potential antioxidants in this setting. Several nanoemulsions were compared in terms of physical characteristics and reactivity to 2,2'-azobis-(2-amidinopropane) hydrochloride (AAPH)-induced oxidation. Formulations included different types of lipids, a detergent (a conjugated bile salt or sodium dodecyl sulfate) and, finally, lipophilic antioxidants. Hemin and myoglobin were also tested as relevant potential oxidants. Fatty acid (FA) peroxidation was monitored by gas chromatography while malondialdehyde and antioxidant contents were measured by HPLC. Investigated nanoemulsions were composed of spherical or cylindrical mixed micelles, the latter being the least resistant to oxidation. In the experimental conditions, AAPH was the only efficient oxidant. Alpha-tocopherol and lutein significantly slowed FA degradation from 4 to 1 μM, respectively. On the contrary, beta-carotene did not show any protective capacity at 4 μM. In conclusion, the tested nanoemulsions were appropriate to assess antioxidant capacity during the intestinal phase of digestion.

Vitamin A deficiency is a public health issue in developing countries and promoting dietary carotenoids as precursors is a promising strategy. However, carotenoids present in numerous fruits and vegetables are unstable and poorly bioaccessible. This study evaluated these two parameters during in vitro digestion of carotenoids and retinoids from carrot juice, raw and cooked spinach, micronutrient-fortified flour and standards without food matrix. Standards were unstable whereas vitamin A from fortified flour and native food carotenoids were generally better protected by the food matrix (30-100% remaining versus 7-30% for standards). Hydrothermal cooking did not influence spinach carotenoid digestive stability but decreased their contents, phenomenon compensated by a significantly better micellarisation from 15-fold for β-carotene to 72-fold for lutein. Finally, carrot juice provided the greatest amount of bioaccessible provitamin A with 1850 μg/100g dry matter (DM) versus 790 and 80 μg/100g DM in cooked and raw spinach, respectively., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Vitamin A deficiency is still one of the major public health problems in least developed countries. Fortification of vegetable oils is a strategy implemented worldwide to prevent this deficiency. For a fortification program to be effective, regular monitoring is necessary to control food quality in the producing units. The reference methods for vitamin A quantification are expensive and time-consuming. A rapid method should be useful for regular assessment of vitamin A in the oil industry. A portable device was compared to high-performance liquid chromatography (HPLC) for three plant oils (rapeseed, groundnut, and soya). The device presented a good linearity from 3 to 30 mg retinol equivalents per kg (mg RE.kg- 1). Its limits of detection and quantification were 3 mg RE.kg- 1 for groundnut and rapeseed oils and 4 mg RE.kg- 1 for soya oil. The intra-assay precision ranged from 1.48 % to 3.98 %, considered satisfactory. Accuracy estimated by the root mean squares error ranged from 3.99 to 5.49 and revealed a lower precision than HPLC (0.4 to 2.25). Although it offers less precision than HPLC, the device estimates quickly the vitamin A content of the tested oils from 3 or 4 to 15 mg RE.kg- 1.

Background: Apart from waist circumference, other adiposity measures, such as subscapular skin fold (SST), arouse growing interest due to their relationship to metabolic complications and cardiovascular risk. The IGF-I system is deregulated in obese subjects in proportion to their degree of visceral adiposity., Aim: To examine the association among IGF-I, IGF-binding protein (BP)-1 and -3 levels and different measures of adiposity in a sample of adult male population in Southern Italy., Materials and Methods: A complete database for this analysis was available for 229 (age range 50-82 yr) participating at 2002-2004 Olivetti Heart Study follow-up., Results: After adjustment for age, IGF-I was inversely associated with body mass index (BMI) and waist circumference (p<0.05). IGFBP-1 was inversely associated with BMI, waist circumference, SST, homeostasis model assessment (HOMA) index, fat mass. HOMA index, age, and SST significantly predicted the IGFBP-1 plasma levels, with 24% of IGFBP-1 variability explained at a linear regression analysis., Conclusions: IGFBP-1 inversely correlated to adiposity and HOMA index. Among adiposity indexes, SST was the best predictor of IGFBP-1 levels. The evaluation of some components of the IGF system, and simple measures of body adiposity, such as SST, may represent a further tool to better evidence phenotype profiles associated to the pathogenetic mechanism of cardiovascular risk factor clustering in male adults.

Excess salt intake impacts on blood pressure (BP) and the pathogenetic mechanisms of atherosclerosis predisposing to stroke and other cardiovascular disorders. The influence of salt starts early in life. Two randomized controlled trials in newborn infants suggest a direct association between dietary sodium intake and BP since the first few months of life. Newborn infants display aversion to the salt taste to develop a "preference" for salt only at age 2-3 years, in part in relation to post-natal events: this preference might be associated with later development of hypertension. The amount of sodium to be retained by an infant for proper physiological growth is largely covered by breast feeding (or low sodium formula milk) in the first six months, and later on by the gradual implementation of complementary feeding, without the need for any added salt upon food preparation. Given the lack of dose-dependence data, reference nutrient intakes (RNI) or adequate intakes (AI) for sodium have been established by national health institutions in various countries. The U.K. RNI was set at 242 mg a day for infants 0-6 months with gradual increase to 0.5 g up until age 3. The U.S. AI is somewhat lower for age 0-6 months but larger for age 1-3 years. According to a recent report, the average sodium intake in U.S. children is close to the AI up to age 2 years, to become progressively greater exceeding the Institute of Medicine recommendation later on., (Copyright © 2012 Elsevier B.V. All rights reserved.)

The recipes of 50 multi-ingredient dishes consumed by the population in an urban district were noted down. The nutritional value was determined as well as the cook value of the dishes in order to evaluate the severity of the thermal treatment. The recipes were simple and involved steps such as boiling, mixing, and cutting. Fibre contents were rather low except when the leaf stems were included. All the dishes had very high beta-carotene content (15.8-25.0 mg/100 g dry matter) and retinol activity equivalent (RAE) (1.3-2.3 mg RAE/100 g dry matter) because of the high proportion of fresh leafy vegetables (from 41.2% to 58.8% of the total dry matter of the ingredients). When meat was added to the preparation, the micronutrient content (iron, zinc, and retinol) was not increased significantly. In three dishes, a positive correlation was found between the thermal treatment severity and the 13-cis-beta-carotene amount.

To analyse the relationship of PAI-1 plasma levels to echographically determined liver steatosis and cardiometabolic risk factors in a randomly selected sample of 254 adult male participants of the Olivetti Heart Study. Accounting for age and ongoing pharmacological treatment, PAI-1 levels were directly (P < 0.005) associated with body mass index (BMI), waist circumference (WC), serum triglyceride (TG), total cholesterol, insulin, homeostasis model assessment index, gamma-glutamyl transpeptidase and peritoneal fat. At multiple linear regression (MLR) analysis, measures of adiposity and TG exerted significant and quantitatively similar effects on PAI-1 levels. A progressive rise in PAI-1 level was detected with increasing degree of steatosis. A stepwise MLR model was used to evaluate the relative power of cardiometabolic risk factors and liver steatosis on PAI-1 levels. Adjusting for alcohol intake, BMI, WC and peritoneal fat were alternatively included in the model with other variables found to be significantly associated with plasma PAI-1 level. Liver steatosis, serum TG and various indexes of adiposity each had a significant independent impact on PAI-1 plasma level and explained overall 23% of its variability. Abdominal fat, liver steatosis and serum TG levels were significant and independent determinants of PAI-1 plasma level in an unselected sample of adult male population upon adjustment for age and therapy.

The impact of deep-fat frying on the micronutrient content of plantain (Musa AAB"barraganete") was evaluated during processing of plantain chips called "tostones." Water content, micronutrients (potassium, L-ascorbic acid, alpha-carotene, beta-carotene) content, and the temperature within the food were quantified during the course of frying. A nonisothermal kinetics analysis of the 1st-order reaction (micronutrient degradation) induced by deep-fat frying, particularly in terms of the spatial distribution of temperature, was proposed. The kinetic parameters (pre-exponential factor k(0,) activation energy E(a)) were identified by nonlinear optimization, minimizing the residual variance between the experimental and theoretical micronutrient content. Agreement between model and experimental values was checked. During 1st and 2nd frying, potassium was well retained while carotenoid contents decreased significantly. Moreover, L-ascorbic acid contents decreased significantly, just during 2nd frying. k(0) was identified as well as E(a) observed for L-ascorbic acid, alpha-carotene, and beta-carotene as 68.4 to 71.5, 79.6 to 84.9, and 85.9 to 88.6 kJ/mol, respectively. beta-carotene appeared to be more heat-resistant than alpha-carotene and L-ascorbic acid. The behavior of the nutritional markers appears to be the consequence of the thermal and hydric histories of the crust and of the heart of the plantain disk related to heat transfer during preparation of the "tostones."

This analysis compares the performance of 7 different diagnostic criteria of metabolic syndrome (MS) with regard to the prevalence of the syndrome, the characteristics of subjects with a positive diagnosis, and the ability to correctly identify individuals at high calculated cardiovascular (CV) risk or with signs of systemic inflammation or early organ damage. The diagnostic criteria proposed by the World Health Organization (1998); European Group for the Study of Insulin Resistance (EGIR) (1999); Adult Treatment Panel III (ATP III) (2001); American Association of Clinical Endocrinologists (AACE) (2003); ATP III (2004); International Diabetes Federation (IDF) (2005); and American Heart Association/National Heart, Lung, and Blood Institute (2005) were applied to the population of 933 men aged 59.5 years (range, 33-81 years) attending the 2002-2004 examination of the Olivetti Heart Study. Standardized measurements were available for body mass index, waist circumference, blood pressure, fasting serum total and high-density lipoprotein cholesterol, triglyceride, glucose, insulin, high-sensitivity C-reactive protein, and microalbuminuria. Insulin resistance was estimated by the homeostasis model assessment index; and CV risk, by the Prospective Cardiovascular Munster algorithm. The MS prevalence ranged from 8.6% (AACE) to 44.5% (IDF). Among MS-positive subjects, insulin resistance ranged from 94.8% (EGIR) to 49.2% (IDF), whereas type 2 diabetes mellitus (excluded by EGIR and AACE criteria) rated 59.9% by World Health Organization and 22% to 24% by ATP III, IDF, or American Heart Association/National Heart, Lung, and Blood Institute. By most criteria, MS-positive subjects had greater calculated CV risk than MS-negative subjects; but in general, the ability to correctly identify individuals at high CV risk was dampened by limited sensitivity (maximum 60%). Lowering the cutoff for abdominal adiposity (waist circumference <94 cm by IDF) did not improve the performance in this regard but identified a larger number of individuals with microalbuminuria (56%) and elevated C-reactive protein (53%).

The diet of 200 randomly selected 1-year-old to 5-year-old children was studied in a rural area of Burkina Faso. The mothers took part in a questionnaire survey and a 24-h dietary recall to index the type and the ingested quantities of the food consumed by the child the previous day. The average percentages of the Recommended Nutrient Intake met by the consumption of a dish component per meal did not exceed 25% for energy, iron, zinc and vitamin A. With respect to their initial composition and the quantities ingested, several dish components such as starchy-based products (millet-based-tô) or sauces (red sorrel leaves, dried okra) were good sources of micronutrients in the children's diets. Several dish components were selected and their preparation observed in six households to obtain precise details of the recipe. Several ingredients (42) and unit operations (nine) were used to prepare the local foods. Cooking in water (boiling), which was the main unit operation, did not exceed 43 min and the temperature used was under 100 degrees C. Several ingredients were subjected to two or three thermal treatments and the duration of cooking reached 56 min in groundnut sauce. The most at-risk unit operations likely to decrease the nutritional quality were cooking in water followed by draining or cooking for a long time.

The effects of the formulation (okra, fish, soumbala, extract of wood ash) and cooking time of okra sauce on total iron and zinc content and on their in vitro digestibility were evaluated following a Doehlert uniform shell design with 5 factors and 33 trials. Cooking time had no significant effect on in vitro digestible iron and zinc content, whereas formulation did. Each ingredient had a specific effect. Extract of wood ash, which is a source of soluble and digestible iron and zinc, is a good way of increasing the digestible mineral content of the dish. Okra, the main ingredient in this sauce, has a negative effect and should be added in moderate quantities (< 37.7% of the DM of the sauce). An optimization using the desirability function allows us to identify the optimal recipe that enabled the quantity of digestible iron to be doubled and the quantity of digestible zinc to be increased by one third. This recipe calls for a mixture of 37.7% okra, 26.3% dried fish, 18.5% soumbala, and 3.7% extract of wood ash cooked for 25 min.

Background: Prosthetic meshes give excellent results in groin hernia repair. However, although recurrence rates are very low, chronic pain remains frequent and mesh fixation may play a role in the occurrence of this complication. The use of fibrin sealant to secure the mesh may represent a useful alternative for the prevention of chronic pain. The aim of this study is to confirm that the mesh may be secured by spraying fibrin sealant and to assess the reduction in the incidence of chronic pain., Methods: Seventy hernias were operated on in 57 patients and were evaluated on a prospective basis. The procedure involved placement of a plug and patch mesh which was secured with fibrin sealant alone. These patients were compared to a matched retrospective series of 57 patients who underwent the same procedure, except that conventional non-absorbable suture was used to secure the mesh., Results: The two groups were equivalent for inclusion criteria and preoperative data. The complication rate was similar in the two groups. The operative time was shorter in the fibrin sealant group: 7 min for unilateral hernia (p=0.0017) and 16 min for bilateral hernia (p=0.0008). The length of hospital stay was also shorter in the fibrin sealant group (1.8 days vs. 2.5 days: p < 0.0001). There was no recurrence in the fibrin sealant group after a minimum follow-up of 12 months and no recurrence in the suture group after a minimum follow-up of 25 months. Finally, a significant reduction in chronic pain was observed in the fibrin sealant group (3.5% vs. 22.8%: p=0.042)., Conclusion: This study confirms the effectiveness of fibrin glue in securing prosthetic meshes and reducing chronic inguinal pain.

Gastrojejunocolic fistulae, a late complication of gastroenterostomy, are presently uncommon. Patients can present with symptoms of a fistula 20 years or more after their original gastric surgery. The knowledge of this rare condition can allow prevention, through a better operative strategy and a medical treatment at the phase of stomal ulcer with proton pump inhibitor and Helicobacter pylori eradication. We present a case of gastrojejunocolic fistula and discuss the modern management of this condition. Its etiological, clinical, and surgical features were briefly discussed.

The influence of thermal treatment (frying of plantain) on the micronutrients ascorbic acid, potassium and carotenoids is evaluated. Cylinders (diameter 30 mm, thickness 10 mm) of plantain (Musa AAB 'barraganete') were fried at four thermal treatments (120-180 degrees C and from 24 to 4 min) to obtain products with approximately the same water content (approximately 0.8+/-0.02 kg/kg1) and fat content (approximately 0.15+/-0.06 kg/kg). The thermal study used the cook value and the mean cook value as indicators of the effect of several different treatment temperatures and times on quality. Deep-fat frying had no significant effect on carotenoid contents at any frying conditions, and on potassium content, except at 120 degrees C and 24 min (loss

Leiomyosarcoma of the oesophagus is a malignant tumor that originates from smooth muscle cells. The filiation between oesophageal leiomyoma and leiomyosarcoma is controversial, with few cases reported in literature. The authors describe un uncommon situation with the simultaneous presence of a leiomyoma and a leiomyosarcoma of the oesophagus in a 75 year-old man, which have been successfully treated with surgical resection. It could probably be a case of a malignant transformation of a previous pre-existing multiple non-confluent leiomyoma.

Penicillium funiculosum Thom. was consistently isolated from pineapple-infected fruitlet (black spots). Polyphenol oxidase, peroxidase, and laccase activities were determined in extracts from contiguous and infected fruitlets. Healthy fruitlets showed a rather high level of polyphenol oxidase (optimum pH 7.0), and this activity was tremendously increased (X 10) in contiguous infected fruitlets. Furthermore, infected fruitlets also exhibited laccase activity (optimum pH 4.0), while peroxidase was rather constant in both fruitlets. Browning reactions were attributed to qualitative and quantitative modifications of the enzymatic equipment (polyphenol oxidase and laccase) (p < 0.0001). In infected fruiltets, sucrose and L-malic acid were present at significantly lower amounts than in healthy ones, likely owing to fungal metabolism (p < 0.0001), whereas cell wall material was three times higher, which could be viewed as a defense mechanism to limit expansion of the mycelium.

Venous leiomyosarcomas are rare tumors, generally originating from the inferior vena cava. Only two cases of ovarian vein leiomyosarcoma have been reported thus far. Herein we report the case of a 50-year-old woman with a leiomyosarcoma of the right ovarian vein. The patient underwent radical en bloc extirpation of the tumor followed by radiation therapy. The clinicopathologic features and treatment are discussed.

Effects of a 20-h fermentation on cell wall polysaccharides from the mucilage of pulped coffee beans were examined and compared to those of unfermented beans, on alcohol insoluble residues (AIRs), their hot-water-soluble crude pectic substances (PECTs), and their hot-water-insoluble residues (RESs). Yields and compositions were very similar: AIRs, which consisted of approximately 30% highly methylated pectic substances, approximately 9% cellulose, and approximately 15% neutral noncellulosic polysaccharides, exhibited no apparent degradation. However, PECTs from fermented beans were shown to have undergone a slight reduction of their intrinsic viscosity and weight-average molecular weight by capillary viscosimetry and high-performance size-exclusion chromatography. After fermentation, hot-water-insoluble pectic substances of RES exhibited partial de-esterification. Removal of coffee bean mucilage by natural fermentation seems to result from a restricted pectolysis, the mechanism of which remains to be elucidated.

The coffee fermentation microflora were rich and mainly constituted of aerobic Gram-negative bacilli, with Erwinia and Klebsiella genuses at the highest frequencies. The best population increase was observed with lactic acid bacteria and yeasts, whereas those microorganisms that counted on a pectin medium remained constant during the fermentation step. Qualitatively, lactic acid bacteria belonged mainly to Leuconostoc mesenteroides species but the others microflora were relatively heterogeneous. The microorganisms isolated on pectin medium were Enterobacteriaceae, identified as Erwinia herbicola and Klebsiella pneumoniae, not reported as strong pectolytic strains. Throughout coffee fermentation, 60% of the simple sugars were degraded by the total microflora and not specifically by pectolytic microorganisms.