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Iron deficiency in infants can impact development, and there are concerns that the use of baby food pouches and baby-led weaning may impair iron status. First Foods New Zealand (FFNZ) was an observational study of 625 New Zealand infants aged 6.9 to 10.1 months. Feeding methods were defined based on parental reports of infant feeding at "around 6 months of age": "frequent" baby food pouch use (five+ times per week) and "full baby-led weaning" (the infant primarily self-feeds). Iron status was assessed using a venepuncture blood sample. The estimated prevalence of suboptimal iron status was 23%, but neither feeding method significantly predicted body iron concentrations nor the odds of iron sufficiency after controlling for potential confounding factors including infant formula intake. Adjusted ORs for iron sufficiency were 1.50 (95% CI: 0.67-3.39) for frequent pouch users compared to non-pouch users and 0.91 (95% CI: 0.45-1.87) for baby-led weaning compared to traditional spoon-feeding. Contrary to concerns, there was no evidence that baby food pouch use or baby-led weaning, as currently practiced in New Zealand, were associated with poorer iron status in this age group. However, notable levels of suboptimal iron status, regardless of the feeding method, emphasise the ongoing need for paying attention to infant iron nutrition.

Since 2001, ChildFund Kenya has supplied micronutrient fortified school meals to preschoolers from two tribes (Kamba and Maasai) attending early childhood development (ECD) centres in Emali, S.E. Kenya. Lack of information on the micronutrient status of the preschoolers prompted a cross-sectional assessment of micronutrient (iron, zinc, selenium, vitamin A, vitamin D) status and prevalence of deficiencies among the two tribes. Data on sociodemographic, health, anthropometric status, and micronutrient supply from preschool meals were collected from 287 Kamba and 213 Maasai children aged 3 to 5 years attending 23 ECD centres. Nonfasting blood samples were collected for haemoglobin and plasma biomarkers of iron, zinc, selenium, vitamin A, vitamin D, C-reactive protein (CRP), α 1 -acid glycoprotein, and immunoglobin G. The prevalence of anaemia was significantly higher in Maasai children than Kamba (38%, 95% CI [31%, 45%], vs. 5%, [3%, 9%]), as well as iron deficiency and its various stages (P < 0.001). No differences were seen in the prevalence of zinc, selenium, vitamin A, or vitamin D deficiencies (all P > 0.05). Body iron, CRP, and age were significant predictors of haemoglobin concentrations for both tribes (all P < 0.006) and plasma 25-OHD for Maasai children only. The higher prevalence of iron deficiency among Maasai than Kamba children was possibly attributed to the high consumption of cow's milk (low in bioavailable iron) in place of micronutrient fortified meals together with a higher prevalence of chronic inflammation and intestinal damage., (© 2019 John Wiley & Sons Ltd.)

Despite growing international interest in Baby-Led Weaning (BLW), we know almost nothing about food and nutrient intake in infants following baby-led approaches to infant feeding. The aim of this paper was to determine the impact of modified BLW (i.e., Baby-Led Introduction to SolidS; BLISS) on food and nutrient intake at 7⁻24 months of age. Two hundred and six women recruited in late pregnancy were randomized to Control ( n = 101) or BLISS ( n = 105) groups. All participants received standard well-child care. BLISS participants also received lactation consultant support to six months, and educational sessions about BLISS (5.5, 7, and 9 months). Three-day weighed diet records were collected for the infants (7, 12, and 24 months). Compared to the Control group, BLISS infants consumed more sodium (percent difference, 95% CI: 35%, 19% to 54%) and fat (6%, 1% to 11%) at 7 months, and less saturated fat (-7%, -14% to -0.4%) at 12 months. No differences were apparent at 24 months of age but the majority of infants from both groups had excessive intakes of sodium (68% of children) and added sugars (75% of children). Overall, BLISS appears to result in a diet that is as nutritionally adequate as traditional spoon-feeding, and may address some concerns about the nutritional adequacy of unmodified BLW. However, BLISS and Control infants both had high intakes of sodium and added sugars by 24 months that are concerning.

Suboptimal zinc status is common in very young children and likely associated with increased risk of infection and detrimental effects on growth. No studies have determined potentially modifiable "predictors" of zinc status in toddlers from high-income countries. This cross-sectional analysis of 115 toddlers from the Baby-Led Introduction to SolidS (BLISS) study used weighed diet records (three non-consecutive days) to assess dietary intake, and a venous blood sample (trace-element free techniques) to assess plasma zinc, at 12 months of age. "Predictors" of plasma zinc were determined by univariate analysis and multiple regression. Mean (SD) plasma zinc was 9.7 (1.5) μmol/L, 60% were below the IZiNCG reference limit of <9.9 μmol/L. Median (25th, 75th percentiles) intake of zinc was 4.4 (3.7, 5.4) mg/day. Red meat intake ( p = 0.004), consumption of zinc-fortified infant formula (3-6 mg zinc/100 g) ( p = 0.026), and food fussiness ( p = 0.028) were statistically significant "predictors" of plasma zinc at 12 months. Although higher intakes of red meat, and consumption of infant formula, are potentially achievable, it is important to consider possible barriers, particularly impact on breastfeeding, cost, and the challenges of behavior modification. Of interest is the association with food fussiness-further research should investigate the direction of this association., Competing Interests: The authors declare no conflict of interest. The funding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Background: It is important for nutrition intervention in malnourished patients to be guided by accurate evaluation and detection of small changes in the patient's nutrition status over time. However, the current Subjective Global Assessment (SGA) is not able to detect changes in a short period. The aim of the study was to determine whether the 7-point SGA is more time sensitive to nutrition changes than the conventional SGA., Methods: In this prospective study, 67 adult inpatients assessed as malnourished using both the 7-point SGA and conventional SGA were recruited. Each patient received nutrition intervention and was followed up after discharge. Patients were reassessed using both tools at 1, 3, and 5 months from baseline assessment., Results: It took significantly shorter time to see a 1-point change using the 7-point SGA compared with the conventional SGA (median: 1 month vs 3 months, P = .002). The likelihood of at least a 1-point change is 6.74 times greater in the 7-point SGA compared with the conventional SGA after controlling for age, sex, and medical specialties (odds ratio, 6.74; 95% confidence interval, 2.88-15.80; P < .001). Fifty-six percent of patients who had no change in SGA score had changes detected using the 7-point SGA. The level of agreement was 100% (κ = 1, P < .001) between the 7-point SGA and 3-point SGA and 83% (κ = 0.726, P < .001) between 2 blinded assessors for the 7-point SGA., Conclusion: The 7-point SGA is more time sensitive in its response to nutrition changes than the conventional SGA. It can be used to guide nutrition intervention for patients., (© 2015 American Society for Parenteral and Enteral Nutrition.)

Background: Nutrition screening is usually administered by nurses. However, most studies on nutrition screening tools have not used nurses to validate the tools. The 3-Minute Nutrition Screening (3-MinNS) assesses weight loss, dietary intake, and muscle wastage, with the composite score of each used to determine risk of malnutrition. The aim of the study was to determine the validity and reliability of 3-MinNS administered by nurses, who are the intended assessors., Methods: In this cross-sectional study, 3 ward-based nurses screened 121 patients aged 21 years and over using 3-MinNS in 3 wards within 24 hours of admission. A dietitian then assessed patients' nutrition status using Subjective Global Assessment within 48 hours of admission, while blinded to the results of the screening. To assess the reliability of 3-MinNS, 37 patients screened by the first nurse were rescreened by a second nurse within 24 hours, who was blinded to the results of the first nurse. The sensitivity, specificity, and best cutoff score for 3-MinNS were determined using the receiver operator characteristics curve., Results: The best cutoff score to identify all patients at risk of malnutrition using 3-MinNS was 3, with sensitivity of 89% and specificity of 88%. This cutoff point also identified all (100%) severely malnourished patients. There was strong correlation between 3-MinNS and SGA (r = .78, P < .001). The agreement between 2 nurses conducting the 3-MinNS tool was 78.3%., Conclusion: The 3-MinNS is a valid and reliable tool for nurses to identify patients at risk of malnutrition.

Background & Aims: Inadequate feeding assistance and mealtime interruptions during hospitalisation may contribute to malnutrition and poor nutritional intake in older people. This study aimed to implement and compare three interventions designed to specifically address mealtime barriers and improve energy intakes of medical inpatients aged ≥ 65 years., Methods: Pre-post study compared three mealtime assistance interventions: PM: Protected Mealtimes with multidisciplinary education; AIN: additional assistant-in-nursing (AIN) with dedicated meal role; PM + AIN: combined intervention. Dietary intake of 254 patients (pre: n = 115, post: n = 141; mean age 80 ± 8) was visually estimated on a single day in the first week of hospitalisation and compared with estimated energy requirements. Assistance activities were observed and recorded., Results: Mealtime assistance levels significantly increased in all interventions (p < 0.01). Post-intervention participants were more likely to achieve adequate energy intake (OR = 3.4, p = 0.01), with no difference noted between interventions (p = 0.29). Patients with cognitive impairment or feeding dependency appeared to gain substantial benefit from mealtime assistance interventions., Conclusions: Protected Mealtimes and additional AIN assistance (implemented alone or in combination) may produce modest improvements in nutritional intake. Targeted feeding assistance for certain patient groups holds promise; however, alternative strategies are required to address the complex problem of malnutrition in this population. AUSTRALIAN NEW ZEALAND CLINICAL TRIALS REGISTRY NUMBER: ACTRN12609000525280., (Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.)

This study aimed to identify 1) the prevalence of malnutrition according to the scored Patient Generated-Subjective Global Assessment (PG-SGA), 2) utilization of available nutrition resources, 3) patient nutrition information needs, and 4) external sources of nutrition information. An observational, cross-sectional study was undertaken at an Australian public hospital on 191 patients receiving oncology services. According to PG-SGA, 49% of patients were malnourished, and 46% required improved symptom management and/or nutrition intervention. Commonly reported nutrition-impact symptoms included peculiar tastes (31%), no appetite (24%), and nausea (24%). External sources of nutrition information were accessed by 37%, with popular choices being media/Internet (n = 19) and family/friends (n = 13). In a subsample (n = 65), 32 patients were aware of the available nutrition resources, 23 thought the information sufficient, and 19 patients had actually read them. Additional information on supplements and modifying side effects was requested by 26 patients. Malnutrition is common in oncology patients receiving treatment at an Australian public hospital, and almost half require improved symptom management and/or nutrition intervention. Patients who read the available nutrition information found it useful; however, awareness of these nutrition resources and the provision of information on supplementation and managing symptoms requires attention.

Objective: To evaluate the utility of body mass index (BMI) and corrected-arm-muscle area (CAMA) as measures of nutritional health for lower-limb amputees attending prosthetics clinics., Design: Cross-sectional study., Setting: Prosthetics clinic in Australia., Participants: Unilateral lower-extremity amputees (N=58; age range, 21-91y; 37 transtibial, 21 transfemoral) attending a regional prosthetics clinic between May and November 2003., Interventions: Not applicable., Main Outcome Measures: Weight (without prosthesis), corrected and uncorrected for the amputated limb was used with height estimated from knee height to calculate corrected BMI (cBMI) and uncorrected BMI (uBMI). CAMA was calculated using the mean of triplicate mid-upper-arm circumference (MUAC) and triceps skinfold thickness (TST) measurements. The Mini Nutritional Assessment (MNA) and Assessment of Quality of Life were administered according to recommended protocols. The Pearson correlation was used to determine the strength and significance of associations between variables, and bivariate regression analyses were performed to determine whether an association existed between the nutritional variables (BMI, CAMA, MNA) and quality of life (QOL)., Results: There were no statistically significant differences in the measures of nutritional health according to site (transtibial, transfemoral) of amputation. MUAC, TST, and CAMA all showed moderate to high positive correlations (r range, .541-.782) with both cBMI and uBMI. The strength of the relationship between the MNA and cBMI/uBMI was weaker (r=.383, r=.380, respectively) but remained positive and statistically significant (P=.003). QOL was not associated with cBMI or uBMI but was related to CAMA (beta=-.132; P=.030) and MNA (beta=-.561; P=.017)., Conclusions: For persons with unilateral lower-extremity amputation, measurement of upper-arm anthropometry may be a more useful indicator of nutritional health and its consequences than BMI.

Background: Malnutrition is associated with poor outcomes in older adults and those admitted to rehabilitation may be particularly at risk. Objective To assess the nutritional status and outcomes of older adults in rehabilitation., Subjects and Methods: We recruited 133 adults > or = 65 years from consecutive rehabilitation admissions. Nutritional status was assessed using the mini nutritional assessment, body mass index (BMI) and corrected arm muscle area (CAMA). Outcomes measured included length of stay, admission to higher level care, function and quality of life (QOL)., Results: Sixty-two (47%) subjects were well nourished, 63 (47%) at risk of malnutrition and eight (6%) malnourished. Twenty-two (17%) and 27 (20%) were below the desirable reference values for BMI and CAMA respectively. Subjects at risk of malnutrition/malnourished had longer length of stay (P = 0.023) and were more likely to be admitted to higher level care (P < 0.05). These subjects also had poorer function on admission (P < 0.001) and 90 days (P = 0.002) and QOL on admission (P < 0.008) and 90 days (P = 0.001). Those with low CAMA were twice as likely to be admitted to higher level care (P < 0.05) and had poorer function at 90 days (P = 0.017)., Conclusions: Over half our sample was identified as at risk of malnutrition or malnourished and this was associated with poorer clinical outcomes.

Objective: To evaluate the fruit and vegetable intakes of 2 to 18-year-old Australians., Methods: Intake data were collected as part of the National Nutrition Survey 1995 representing all Australian States and Territories, urban, rural and remote areas. Dietary intake of 3,007, two to 18-year-olds was assessed using a 24-hour structured diet recall method. Intake frequency was assessed as the percentage of participants consuming fruit and vegetables on the surveyed day, and variety was assessed as the number of sub-groups of fruit and vegetables eaten. Intake levels were compared with the recommendations of the Australian Guide to Healthy Eating, the 1993 Goals and Targets for Australia's Health in 2000 and beyond, and intakes of the 1985 National Dietary Survey., Results: One-quarter of children and adolescents did not eat fruit on the day of survey and one fifth did not eat vegetables. Adolescents were less likely to include fruit (65%) than young children (80%) but slightly more adolescents (85%) included vegetables than young children (77%). Less than 50% of all participants (<25% of adolescents) had an adequate fruit intake, and only one-third of children and adolescents met the vegetable intake recommendations., Conclusions: Fruit and vegetable intakes of Australian children and adolescents fall well below recommendations and appear to have declined in the past 10 years., Implications: Strategic approaches involving a broad range of sectors are urgently needed to create a supportive environment for consuming recommended levels of a wide variety of fruit and vegetables.

Objective: This study was undertaken to investigate the metabolism of selenite in men with life-long intakes of deficient, adequate and excess selenium., Methods: Stable isotopes of selenium were infused for five hours into Chinese men living in deficient, adequate or excessive selenium areas, and 24-hour urine and blood samples were collected daily for the next seven days. Stable isotopic selenium excretion was determined in urine and in whole plasma and plasma fractions., Results: Even though there was a positive correlation of selenium intake with the urinary excretion of this element, this relationship was not linear over the entire range (deficient, adequate, excessive) of selenium intake. When the urine excretion was normalized internally within each group, a sharp increase in the slope of this relationship was found when long-term intake increased to adequate amounts, but the slope reached a plateau when the daily intake exceeded the adequate group. The plasma selenoprotein P fraction was labeled initially, but the incorporation in the glutathione peroxidase fraction subsequently increased by a small amount. A two-month dietary restriction of selenium of the subjects from the excess area did not result in a reduction of urinary excretion of infused selenite., Conclusion: A complex relationship exists between long-term intake of selenium and selenium status, and subjects living in the excess area are more saturated with selenium than anticipated. More than two months of depletion are required to affect urinary excretion of selenium.

The purpose of the present study was to investigate the effects of Se restriction on the excretion of Se in men who had consumed high levels of this element during their entire lives. With the use of stable isotopes of Se as selenite, the excretion of methylated Se in urine was investigated in Chinese men (n 10) who had habitual chronic high intakes of this element. The relationship between either urine Se or trimethylselenonium (TMSe) to the estimated long-term Se intake was not linear over the entire range of intake, which was also true for the infusion of labelled selenite. A non-linear relationship was also found between urine TMSe and urine Se both for TMSe arising from catabolism of endogenous body Se and that from infused selenite. The data suggest a close precursor-product relationship of urine Se and its TMSe component based on the nearly identical specific activities for these two selenocompounds. Although dimethylselenide in breath was not measured in the present study, combining urinary TMSe with this breath test may be more useful in the assessment of long-term Se status.

Background: The antioxidant enzyme glutathione peroxidase is a selenoprotein that, in adults with low selenium intakes, has a strong linear relationship with blood selenium and hence is used as a functional indicator of selenium status. Our aim was to evaluate glutathione peroxidase as a functional marker of selenium status in preterm infants., Methods: Erythrocyte glutathione peroxidase activity and plasma and erythrocyte selenium were measured between days 1-5 and then weekly until discharge in 63 preterm infants with mean +/- standard error birth weight and gestation of 1572+/-60g and 30.7+/-0.3 weeks. A healthy reference group of term infants (n = 46) was assessed at day 5 and at 6 weeks., Results: In preterm infants, over the first 3 months, the association of glutathione peroxidase activity with erythrocyte selenium was weak and inconsistent and nonexistent with selenium intake or plasma selenium. No correlations between any of these indicators were evident for term infants. In preterm infants, plasma and erythrocyte selenium declined over the first 6 weeks (p < 0.01), while glutathione peroxidase activity increased (p < 0.05). In term infants, plasma selenium increased (p < 0.001), but there was no change in erythrocyte selenium or glutathione peroxidase activity. For preterm infants, glutathione peroxidase activities at weeks 4 and 6 were associated with maximum inspired oxygen concentration, ventilator pressure, and days of ventilation., Conclusions: This data is consistent with animal and in vitro evidence that glutathione peroxidase may be confounded by oxygen. We conclude that erythrocyte glutathione peroxidase activity is not a reliable functional marker of preterm selenium status in the neonatal period.