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In order to prioritise interventions for micronutrient deficiencies in China, the populations affected by iron and zinc deficiencies were assessed based on data from the 2002 China National Nutrition and Health Survey. The costs and cost-effectiveness of supplementation, food diversification and food fortification were estimated using the standard World Health Organization ingredients approach. Results indicated that 30% of children (60 years), pregnant and lactating women, and 20% of women of reproductive age were anaemic, some 245 million people. Approximately 100 million people were affected by zinc deficiency (zinc intake inadequacy and stunting), the majority living in rural areas. Among interventions on iron and zinc deficiency, biofortification showed the lowest costs per capita, I 0.01 (international dollars), while dietary diversification through health education represented the highest costs at I 1148(international dollars). The cost-effectiveness of supplementation, food fortification and dietary diversification for iron deficiency alone was I 179(international dollars) , I 66 and I 103 (international dollars) per disability-adjusted life-year (DALY), respectively. Data for biofortification were not available. For zinc deficiency, the corresponding figures were I 399(international dollars), I 153(international dollars) and I 103(international dollars) per DALY, respectively. In conclusion, iron and zinc deficiencies are of great public health concern in China. Of the two long-term intervention strategies, i.e. dietary diversification and biofortification with improved varieties, the latter is especially feasible and cost-effective for rural populations. Supplementation and fortification can be used as short-term strategies for specific groups.

Aims To assess the relationship between fish consumption or eicosapentaenoic acid (EPA)+docosahexaenoic acid (DHA) intake from fish, and (sudden) coronary death. Methods and results The impact of recent and long-term fish consumption and EPA+DHA intake on (sudden) coronary death was investigated in the Zutphen Study, a cohort of 1373 men born between 1900 and 1920, and examined repeatedly between 1960 and 2000. Hazard ratios were obtained from time-dependent Cox regression models. The associations between long-term fish consumption, EPA+DHA intake, and (sudden) coronary death were stronger than those of recent consumption. Long-term fish consumption was inversely associated (borderline significant) with coronary heart disease (CHD) death; however, the strength of the association decreased from age 50 [HR: 0.32 (95% CI: 0.13–0.80)] until age 80 [HR: 1.34 (0.58–3.12)]. For men with a daily EPA+DHA intake from fish below 250 mg compared with no intake, CHD death risk was reduced to the same extent as for men with a daily intake above 250 mg ( P -value for trend: 0.27). Moreover, long-term fatty-fish consumption lowered the risk of sudden coronary death [HR: 0.46 (0.27–0.78)]. Conclusion The strength of the association between long-term fish consumption and CHD death decreased with increasing age. Fatty-fish consumption lowered sudden coronary death risk. There was no clear dose–response relationship between EPA+DHA intake and (sudden) coronary death.

Folate, a water-soluble B vitamin, is a cofactor in one-carbon metabolism and is essential for DNA synthesis, amino acid interconversion, methylation and, consequently, normal cell growth. In animals with existing pre-neoplastic and neoplastic lesions, folic acid supplementation increases the tumour burden. To identify processes that are affected by increased folic acid levels, we compared HT29 human colon cancer cells exposed to a chronic supplemental (100 ng/ml) level of folic acid to cells exposed to a normal (10 ng/ml) level of folic acid, in the presence of vitamin B12and other micronutrients involved in the folate–methionine cycle. In addition to higher intracellular folate levels, HT29 cells at 100 ng folic acid/ml displayed faster growth and higher metabolic activity. cDNA microarray analysis indicated an effect on cell turnover and Fe metabolism. We fully confirmed these effects at the physiological level. At 100 ng/ml, cell assays showed higher proliferation and apoptosis, while gene expression analysis and a lower E-cadherin protein expression indicated decreased differentiation. These results are in agreement with the promoting effect of folic acid supplementation on established colorectal neoplasms. The lower expression of genes related to Fe metabolism at 100 ng folic acid/ml was confirmed by lower intracellular Fe levels in the cells exposed to folic acid at 100 ng/ml. This suggests an effect of folate on Fe metabolism.

Background: Very-long-chain n-3 polyunsaturated fatty acids (n-3 PUFAs) are suggested to be related to cognitive performance in older adults. However, limited data exist on the association between n-3 PUFAs and performance in specific cognitive domains. Objective: We evaluated the association between plasma n-3 PUFA proportions and cognitive performance in 5 cognitive domains and determined whether plasma n-3 PUFA proportions predict cognitive change over 3 y. Design: We used data from the FACIT trial, in which participants received folic acid or placebo capsules for 3 y. Fatty acid proportions in plasma cholesteryl esters at baseline were measured in 807 men and women aged 50-70 y. Cognitive performance for memory, sensorimotor speed, complex speed, information-processing speed, and word fluency was assessed at baseline and after 3 y. The crosssectional analyses were based on all 807 participants; the longitudinal analyses were based only on 404 participants in the placebo group. Results: Higher plasma n-3 PUFA proportions predicted less decline in sensorimotor speed (multiple linear regression coefficient, z score = 0.31; 95% CI: 0.06, 0.57) and complex speed (0.40; 95% CI: 0.10, 0.70) over 3 y. Plasma n-3 PUFA proportions did not predict 3-y changes in memory, information- processing speed, or word fluency. The cross-sectional analyses showed no association between plasma n-3 PUFA proportions and performance in any of the 5 cognitive domains. Conclusions: In this population, plasma n-3 PUFA proportions were associated with less decline in the speed-related cognitive domains over 3 y. These results need to be confirmed in randomized controlled trials.

Background Anemia is a significant public health problem among schoolchildren in Vietnam. Food fortification is considered one of the most sustainable long-term strategies to control iron-deficiency anemia in Vietnam. The success of a food-fortification program depends on the choice of the food vehicle. Objectives The aim of the present study was to identify an appropriate vehicle for iron fortification to be used in a school-feeding program aimed at improving the iron and anemia status of schoolchildren in rural Vietnam. Methods Children 6 to 8 years of age in two primary schools in Tam Nong District, Phu Tho Province, and their parents were included in this study. The study consisted of three substudies: a food-consumption study with 24-hour recalls of two nonconsecutive days; a food-beliefs study, with focus group discussions, a pile-sorting test, and a food attributes and differences exercise; and a food-acceptance study using noodles and biscuits fortified with sodium iron ethylenediaminetetraacetic acid (NaFeEDTA). Results The average number of meals consumed daily was 3.2 ± 0.4, and the average intakes of energy and iron were 1,218 ± 406 kcal and 7.5 ± 4.0 mg, respectively. Compared with biscuits and instant rice soup, instant noodles were consumed more frequently and in larger portion sizes and are more acceptable as children's food in the culture of the local people. The iron level of the fortified product did not affect the mean consumption of noodles, but a higher level of iron was associated with a lower mean consumption of biscuits ( p < .05). The production process did not affect the NaFeEDTA level in noodles; however, during preparation at least 70% of the iron is leaked into the soup. Conclusions Instant noodles are a suitable vehicle for iron fortification for use in school-based intervention to improve iron-deficiency anemia among primary schoolchildren in rural Vietnam.

Study objective: To study the effect of long-term smoking on all-cause and cause-specific mortality, and to estimate the effects of cigarette and cigar or pipe smoking on life expectancy. Design: A long-term prospective cohort study. Setting: Zutphen, The Netherlands. Participants: 1373 men from the Zutphen Study, born between 1900 and 1920 and studied between 1960 and 2000. Measurements: Hazard ratios for the type of smoking, amount and duration of cigarette smoking, obtained from a time-dependent Cox regression model. Absolute health effects of smoking are expressed as differences in life expectancy and the number of disease-free years of life. Main results: Duration of cigarette smoking was strongly associated with mortality from cardiovascular disease, lung cancer and chronic obstructive pulmonary disease, whereas both the number of cigarettes smoked as well as duration of cigarette smoking were strongly associated with all-cause mortality. Average cigarette smoking reduced the total life expectancy by 6.8 years, whereas heavy cigarette smoking reduced the total life expectancy by 8.8 years. The number of total life-years lost due to cigar or pipe smoking was 4.7 years. Moreover, cigarette smoking reduced the number of disease-free life-years by 5.8 years, and cigar or pipe smoking by 5.2 years. Stopping cigarette smoking at age 40 increased the life expectancy by 4.6 years, while the number of disease-free life-years was increased by 3.0 years. Conclusions: Cigar or pipe smoking reduces life expectancy to a lesser extent than cigarette smoking. Both the number of cigarettes smoked and duration of smoking are strongly associated with mortality risk and the number of life-years lost. Stopping smoking after age 40 has major health benefits.

Background Sodium iron edetic acid (NaFeEDTA) might be a more bioavailable source of iron than electrolytic iron, when added to maize flour. We aimed to assess the effect, on children's iron status, of consumption of whole maize flour fortified with iron as NaFeEDTA or electrolytic iron. Methods 516 children, aged 3-8 years, from four schools in Marafa, Kenya, were randomly assigned to four groups. All were given the same amount of porridge five times a week. The porridge for one group was made from unfortified whole maize flour; for the other three groups it was fortified with either high-dose NaFeEDTA (56 mg/kg), low-dose NaFeEDTA (28 mg/kg), or electrolytic iron (56 mg/kg). Concentrations of haemoglobin, plasma ferritin, and transferrin receptor were analysed in samples taken at baseline and at the end of the 5-month intervention. The primary outcome was iron-deficiency anaemia. We analysed data on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, number NCT00386074. Findings The prevalence of iron-deficiency anaemia in children given unfortified flour was 10%. Compared with placebo, the prevalence of iron-deficiency anaemia in children given flour fortified with high-dose NaFeEDTA, low-dose NaFeEDTA, and electrolytic iron changed by -89% (95% CI -97% to -49%), -48% (-77% to 20%), and 59% (-18% to 209%), respectively. Consumption of high-dose NaFeEDTA improved all measured iron-status indicators. Low-dose NaFeEDTA decreased the prevalence of iron deficiency but did not noticeably change the prevalence of anaemia. Electrolytic iron did not improve any of these iron-status indicators. Children who were iron-deficient at baseline benefited more from high-dose and low-dose NaFeEDTA than those with sufficient iron at baseline. Interpretation Consumption of whole maize flour fortified with NaFeEDTA caused modest, dose-dependent improvements in children's iron status. Fortification with electrolytic iron did not improve their iron status. Therefore, in high-phytate flours, NaFeEDTA is more suitable than electrolytic iron for supplementation of iron in the diet.

Summary Background Low folate and raised homocysteine concentrations in blood are associated with poor cognitive performance in the general population. As part of the FACIT trial to assess the effect of folic acid on markers of atherosclerosis in men and women aged 50–70 years with raised plasma total homocysteine and normal serum vitamin B 12 at screening, we report here the findings for the secondary endpoint: the effect of folic acid supplementation on cognitive performance. Methods Our randomised, double blind, placebo controlled study took place between November, 1999, and December, 2004, in the Netherlands. We randomly assigned 818 participants 800 μg daily oral folic acid or placebo for 3 years. The effect on cognitive performance was measured as the difference between the two groups in the 3-year change in performance for memory, sensorimotor speed, complex speed, information processing speed, and word fluency. Analysis was by intention-to-treat. This trial is registered with clinicaltrials.gov with trial number NCT00110604. Findings Serum folate concentrations increased by 576% (95% CI 539 to 614) and plasma total homocysteine concentrations decreased by 26% (24 to 28) in participants taking folic acid compared with those taking placebo. The 3-year change in memory (difference in Z scores 0·132, 95% CI 0·032 to 0·233), information processing speed (0·087, 0·016 to 0·158) and sensorimotor speed (0·064, −0·001 to 0·129) were significantly better in the folic acid group than in the placebo group. Interpretation Folic acid supplementation for 3 years significantly improved domains of cognitive function that tend to decline with age.

Hypertension has recently been identified as the leading risk factor for global mortality. This study aims to present the national prevalence of hypertension and prehypertension and, their determinants in Vietnamese adults.Nationally representative data were obtained from the National Adult Overweight Survey 2005. This one visit survey included 17,199 subjects aged 25-64 years, with a mean body mass index (BMI) of 20.7 kg/m(2).The overall census-weighted JNC7 (the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) defined prevalence of hypertension was 20.7% (95% confidence interval (CI) = 19.4-22.1); the prevalence of prehypertension was 41.8% (95% CI = 40.4-43.1). Hypertension and prehypertension were more prevalent in men. Higher age, overweight, alcohol use (among men), and living in rural areas (among women) were independently associated with a higher prevalence of hypertension, whereas higher physical activity and education level were inversely associated. Age, BMI, and living in rural areas were independently associated with an increased prevalence of prehypertension. Among the hypertensives, 25.9% were aware of their hypertension, 12.2% were being treated, and 2.8% had their blood pressure under control; among the treated hypertensives, 32.4% had their blood pressure controlled.Hypertension and prehypertension are prevalent in Vietnam, but awareness, treatment, and control are low. The findings suggest that lifestyle modifications, including the prevention of overweight, the promotion of physical activity particularly in urban areas, and the reduction of high alcohol consumption, may help to prevent hypertension in Vietnam. Furthermore, increased efforts regarding education, detection, and treatment could be important in management of hypertension and cardiovascular disease risk prevention.

Vitamin D is a fat-soluble hormone that traditionally has been linked to bone health. Recently, its involvement has been extended to other (extra-skeletal) disease areas, such as cancer, CVD, energy metabolism and autoimmune diseases. Vitamin D deficiency is a worldwide problem, and several recommendation-setting bodies have published guidelines for adequate vitamin D intake and status. However, recommendations from, for example, the Health Council of the Netherlands do not provide advice on how to treat vitamin D deficiency, a condition that is often encountered in the clinic. In addition, these recommendations provide guidelines for the maintenance of ‘minimum levels’, and do not advise on ‘optimum levels’ of vitamin D intake/status to further improve health. The NutriProfiel project, a collaboration between the Gelderse Vallei Hospital (Ede, the Netherlands) and the Division of Human Nutrition of Wageningen University (Wageningen, the Netherlands), was initiated to formulate a protocol for the treatment of vitamin deficiency and for the maintenance of optimal vitamin D status. To discuss the controversies around treatment of deficiency and optimal vitamin D status and intakes, a workshop meeting was organised with clinicians, scientists and dietitians. In addition, a literature review was conducted to collect recent information on optimal intake of vitamins, their optimal circulating concentrations, and effective dosing regimens to treat deficiency. This information has been translated into the NutriProfiel advice, which is outlined in this article.

The effect of a repeated monotonous exposure on ad libitum intake, pleasantness and boredom in elderly people in a real life situation is unclear. We therefore investigated the effects of repeated exposure to ad libitum intake of three orange-based drinks on boredom and acceptance in young and elderly people. Young (n=32) and elderly women (n=36) participated in a randomized within subjects cross over trial with three intervention periods of 12 days each followed by a 2-day wash out period. During each intervention period, the participants received 1 L of one type of drink per day. The three drinks varied in sweetness intensity. Intake was measured by weighing the returned packets and pleasantness, boredom and sweetness were rated on a 10-point scale. For the young women, mean consumption of the three drinks (p

Objective: To assess the phytate intake and molar ratios of phytate to calcium, iron and zinc in the diets of people in China. Design: 2002 China Nationwide Nutrition and Health Survey is a cross-sectional nationwide representative survey on nutrition and health. The information on dietary intakes was collected using consecutive 3 days 24|[thinsp]|h recall by trained interviewers. Subjects: The data of 68|[thinsp]|962 residents aged 2|[ndash]|101 years old from 132 counties were analyzed. Results: The median daily dietary intake of phytate, calcium, iron and zinc were 1186, 338.1, 21.2 and 10.6|[thinsp]|mg, respectively. Urban residents consumed less phytate (781 vs 1342|[thinsp]|mg|[sol]|day), more calcium (374.5 vs 324.1|[thinsp]|mg|[sol]|day) and comparable amounts of iron (21.1 vs 21.2|[thinsp]|mg|[sol]|day) and zinc (10.6 vs 10.6|[thinsp]|mg|[sol]|day) than their rural counterparts. A wide variation in phytate intake among residents from six areas was found, ranging from 648 to 1433|[thinsp]|mg|[sol]|day. The median molar ratios of phytate to calcium, iron, zinc and phytate |[times]| calcium|[sol]|zinc were 0.22, 4.88, 11.1 and 89.0, respectively, with a large variation between urban and rural areas. The phytate:zinc molar ratios ranged from 6.2 to 14.2, whereas the phytate |[times]| calcium|[sol]|zinc molar ratios were from 63.7 to 107.2. The proportion of subjects with ratios above the critical values of phytate to iron, phytate to calcium, phytate to zinc and phytate |[times]| calcium|[sol]|zinc were 95.4, 43.7, 23.1 and 8.7|[percnt]|, respectively. All the phytate|[sol]|mineral ratios of rural residents were higher than that of their urban counterparts. Conclusions: The dietary phytate intake of people in China was higher than those in Western developed countries and lower than those in developing countries. Phytate may impair the bioavailability of iron, calcium and zinc in the diets of people in China

Vascular disease and its risk factors have been associated with the age-related hearing loss. We examined the association of elevated plasma homocysteine and its determinants with hearing levels. Pure-tone air conduction thresholds in 728 individuals with sensorineural hearing loss were not associated with homocysteine, erythrocyte folate and Vitamin B6. Low concentrations of serum folate and Vitamin B12 were associated with better hearing. When folate status was below the median, 5,10-methylenetetrahydrofolate reductase (MTHFR) 677TT homozygotes had similar hearing levels to subjects with a C allele. However, when folate status was above the median, MTHFR 677TT homozygotes had on an average 5 dB (p = 0.037) and 2.6 dB (p = 0.021) lower PTA-high and PTA-low hearing thresholds, respectively, than the subjects with a 677C allele. The relationship between serum folate and hearing thresholds appeared to be dependent on MTHFR 677 genotype (CC, r = 0.13, p = 0.034; TT, r = -0.10, p = 0.291). This supports the hypothesis that a greater one-carbon moiety commitment to de novo synthesis of nucleotides and an increase in formyl-folate derivatives relative to methyl-folate derivatives is protective for hearing.

Secretory immunoglobulin A (SIgA) plays an important role in the defence of the gastrointestinal tract. The level of faecal SIgA antibody is associated with increased neutralization and clearance of viruses. Formula-fed infants who lack the transfer of protective maternal SIgA from breast milk may benefit from strategies to support maturation of humoral immunity and endogenous production of SIgA. We aimed at studying the effects of standard, prebiotic and probiotic infant formulas on the faecal SIgA levels. At birth, infants of whom the mother had decided not to breastfeed were allocated to one of three formula groups in a randomized, double-blind fashion. Nineteen infants received standard infant formula; 19 received prebiotic formula containing a specific mixture of 0.6 g galacto-oligosaccharides (GOS)/fructo-oligosaccharides (FOS)/100 ml formula and 19 received probiotic formula containing 6.0 × 109 cfu Bifidobacterium animalis/100 ml formula. Faecal samples were taken on postnatal day 5, day 10, wk 4 and every 4 wk thereafter until wk 32. SIgA in faeces was determined by an enzyme-linked immunosorbent assay. During the intervention, infants fed on prebiotic formula showed a trend towards higher faecal SIgA levels compared with the standard formula-fed infants reaching statistical significance at the age of 16 wk. In contrast, infants fed on the probiotic formula showed a highly variable faecal SIgA concentration with no statistically significant differences compared with the standard formula group. Formula-fed infants may benefit from infant formulas containing a prebiotic mixture of GOS and FOS because of the observed clear tendency to increase faecal SIgA secretion. Adding viable B. animalis strain Bb-12 to infant formula did not reveal any sign for such a trend. Secretory immunoglobulin A (SIgA) is one of the most abundant immunoglobulin in the human body and is the predominant immunoglobulin in mucosal surfaces. SIgA plays a key role in the gastrointestinal defence mechanism against dietary and microbial antigens. It inhibits adherence and invasion of potentially harmful antigens into mucosal tissues and neutralizing toxins and virulence factors from microbial pathogens (1). It is well established that the level of faecal SIgA antibody correlates with higher virus-neutralizing capacity and increased viral clearance (2). IgA deficiency in humans is one of the most common immunodeficiencies and is associated with frequent gastrointestinal infections (3). There is accumulating evidence that the intestinal SIgA production is highly influenced by the intestinal microflora. Indeed, the development of the IgA-producing plasmablasts (intermediate stage of the development of a B-lymphocyte into IgA-producing plasma cell) in the intestinal mucosa seems to be affected by components of the intestinal microflora (4). During the first few weeks after birth, the mucosal humoral immunity is not in a mature state. Passive immunity in this phase is provided by breast milk, which contains high levels of SIgA and antimicrobial peptides. SIgA in breast milk are mainly directed against the mother's previous and current gut microflora (5). Breast milk SIgA protects the maternal mammary gland against mastitis, protects the neonatal mucosa against early exposure to microbes and limits bacterial translocation. In breast milk, SIgA levels are highest during the first days after birth (human colostrum contains 2¿5 mg SIgA/ml) and then gradually decrease to 0.5¿1 mg/ml (6). Although many factors may influence SIgA survival in the large intestine, measuring SIgA levels in faeces gives a good representation of the amount available in the colon (7). In the first 2¿4 wk of life, the concentration of IgA in faeces of breast-fed infants is substantially higher compared to that found in formula-fed infants in whom SIgA is basically undetectable (8). Between 4 wk and 6 months of life, faecal IgA concentrations in both breast-fed and formula-fed infants converge towards similar levels. At age 1¿2 yr, when weaning is completed, the production of SIgA reaches adult levels (9). It is generally recognized that intestinal microflora may play an active role in the ontogeny of the newborn's immune response. Studies performed in germ-free animals showed that colonization leads to the development of the gut-associated lymphoid tissue, including SIgA secretion in the intestine (10, 11). Moreau and Baforiau-Routhiau have shown that in particular bifidobacteria in the infant's intestine are important for the synthesis of IgA against viral enteropathogens. Therefore, they suggested that foods promoting bifidobacteria in the intestine could be instrumental in stimulating endogenous SIgA production and hence promote resistance in infants (12). Although the mechanism of immune stimulation by bifidobacteria is largely unknown, it is thought that the cell walls of Gram-positive bacteria, which are rich in peptidoglycans, may play a role. Both prebiotics and probiotics change the intestinal microflora by increasing the numbers of bifidobacteria and lactobacilli. Bifidobacteria and lactobacilli have various beneficial effects in health and disease, including maintenance of intestinal barrier integrity and mucoprotection, stimulation of protective immune responses and protection against harmful pathogens. During the last decade, interest on the immune effects of probiotics has increased markedly. Experimental studies showed that probiotics have strain-specific effects on immunity, for instance in the prevention or treatment of allergic disease. The reported effects of probiotics include enhancement of gut barrier function and induction of regulatory and pro-inflammatory immune responses (13). Additionally, several studies reported that supplementation of food with prebiotics or probiotics can increase SIgA response to viruses and bacteria. However, most of these studies were performed in animals or in vitro and the mechanisms for this immune stimulation are largely unknown (14¿18). As infants not receiving breast milk have lower SIgA levels during the first months of life, they would potentially benefit from strategies to support maturation and production of mucosal SIgA. Therefore, we studied the effects of infant formula with added probiotics or prebiotics on the faecal SIgA levels in infants. We hypothesized that infants on probiotics or prebiotics will have higher levels of total faecal SIgA compared with infants fed on a standard, unsupplemented infant formula

ObjectiveTo assess the effectiveness of a behaviour change approach, with or without financial support, in improving vitamin A (VA) intake and serum retinol concentration through mango and liver consumption by children.DesignA parallel design (no control area) was used to assess changes in VA intake and serum retinol over a 15-week period.Setting and subjectsA pilot study was implemented in the Department of Kokologho, a rural area in central west Burkina Faso. One hundred and fifty children aged 2–3 years were randomly selected and assigned to two treatment groups: PA$$ (promotional activities and financial support) and PA (promotional activities).ResultsThe intervention significantly increased (PPP=0.004) in PA$$ compared with PA. Mean serum retinol concentration increased significantly by 26% (PP−1 in PA$$ vs. 0.17 μmol l−1 and in PA) did not differ significantly (P=0.455) between groups over the intervention.ConclusionPromotional activities on mango and liver intake effectively increased VA intake and serum retinol concentrations. Although an additional beneficial effect of financial support on liver intake was observed, this did not translate into a further increase in serum retinol concentration.

Background. Social facilitation and meal ambiance have beneficial effects on food intake in healthy adults. Extrapolation to the nursing home setting may lead to less malnutrition among the residents. Therefore, we investigate the effect of family-style meals on energy intake and the risk of malnutrition in Dutch nursing home residents. Methods. In 2002 and 2003, a randomized controlled trial was conducted among 178 residents (mean age 77 years) in five Dutch nursing homes. Within each home, two wards were randomized into an intervention (n ¼ 94) and a control group (n ¼84). For 6 months, the intervention group received their meals family style, and the control group received the usual individual preplating services. Outcome measures were intakes of energy (kJ), carbohydrates (g), fat (g), and protein (g) and Mini Nutritional Assessment (MNA) score (0‐30). Results. The change in daily energy intake between the control and intervention group differed significantly (991 kJ; 95% confidence interval [CI], 504‐1479). The difference in intake of macronutrients was 29.2 g (95% CI, 13.5‐44.9) for carbohydrate, 9.1 g (95% CI, 2.9‐15.2) for fat, and 8.6 g (95% CI, 3.4‐13.6) for protein. The percentage of residents in the intervention group classified by the MNA as malnourished decreased from 17% to 4%, whereas this percentage increased from 11% to 23% in the control group. Conclusions. Family-style meals stimulate daily energy intake and protect nursing home residents against malnourishment. Therefore, replacement of the preplating meal services with family-style meals in nursing homes is recommended.

ObjectiveThe purpose of this paper is to examine the relationship between childhood undernutrition and poverty in urban and rural areas.DesignAnthropometric and socio-economic data from Multiple Indicator Cluster Surveys in Angola-Secured Territory (Angola ST), Central African Republic and Senegal were used in this analysis. The population considered in this study is children 0–59 months, whose records include complete anthropometric data on height, weight, age, gender, socio-economic level and urban or rural area of residence. In addition to simple urban/rural comparisons, the population was stratified using a wealth index based on living conditions and asset ownership to compare the prevalence, mean Z-score and odds ratios for stunting and wasting.ResultsIn all cases, when using a simple urban/rural comparison, the prevalence of stunting was significantly higher in rural areas. However, when the urban and rural populations were stratified using a measure of wealth, the differences in prevalence of stunting and underweight in urban and rural areas of Angola ST, Central African Republic and Senegal disappeared. Poor children in these urban areas were just as likely to be stunted or underweight as poor children living in rural areas. The odds ratio of stunting in the poorest compared with the richest quintile was 3.4, 3.2 and 1.5 in Angola ST, Senegal and Central African Republic, respectively.ConclusionsThis paper demonstrates that simple urban/rural comparisons mask wide disparities in subgroups according to wealth. There is a strong relationship between poverty and chronic undernutrition in both urban and rural areas; this relationship does not change simply by living in an urban environment. However, urban and rural living conditions and lifestyles differ, and it is important to consider these differences when designing programmes and policies to address undernutrition.

Objective To assess the effect of family style mealtimes on quality of life, physical performance, and body weight of nursing home residents without dementia. Design Cluster randomised trial. Setting Five Dutch nursing homes. Participants 178 residents (mean age 77 years). Two wards in each home were randomised to intervention (95 participants) or control groups (83). Intervention During six months the intervention group took their meals family style and the control group received the usual individual pre-plated service. Main outcome measures Quality of life (perceived safety; autonomy; and sensory, physical, and psychosocial functioning), gross and fine motor function, and body weight. Results The difference in change between the groups was significant for overall quality of life (6.1 units, 95% confidence interval 2.1 to 10.3), fine motor function (1.8 units, 0.6 to 3.0), and body weight (1.5 kg, 0.6 to 2.4). Conclusion Family style mealtimes maintain quality of life, physical performance, and body weight of nursing home residents without dementia. Trial registration Clinical trials NCT00114582

OBJECTIVE: Animal studies show that the leptin decline after acute severe caloric restriction is a peripheral signal to increase food intake. However, most human studies have failed to observe such a relationship. We studied the acute effects of severe caloric restriction on the association between serum leptin concentrations and subjective appetite. SUBJECTS: A total of 44 healthy adult men (aged: 43 +/- 5 years; BMI: 27.3 +/- 3.2 kg/m(2)). MEASUREMENTS: Fasting serum leptin concentrations and self-perceived appetite levels were measured during a 4-day diet containing 36% of the estimated energy requirements. Appetite levels were assessed with a 10-point Likert scale, reflecting hunger, fullness, desire to eat, prospective consumption and total appetite. RESULTS: After the 4-day energy deficit, fasting leptin concentrations decreased by 39.4% (95% CI: -43.6; -34.9%). This decline was associated with an increase in fasting hunger (r = -0.42; P < 0.01), desire to eat (r = -0.39; P < 0.05) and total appetite (r = -0.38; P < 0.05). Furthermore, the association between fasting leptin concentrations and fasting appetite levels became stronger during the energy restriction period (for total appetite: day 0 r = -0.15, P = 0.32; day 2 r = -0.31, P =< 0.05; day 4 r = -0.41, P < 0.01). CONCLUSIONS: The acute proportional reduction in fasting leptin after 4-day energy restriction is associated with an increase in self-perceived appetite. Additionally, the inverse association between proportional fasting leptin concentrations and self-perceived appetite response becomes stronger as energy restriction is prolonged. These findings suggest that leptin has an instrumental role in restoring energy balance in humans through the expression of appetite.

Aim: We examined whether total homocysteine, B vitamins and the 5,10-methylenetetrahydrofolate reductase (MTHFR) 677C→T polymorphism are related to common carotid intima-media thickness, a marker of atherosclerosis, and carotid distension, a marker of arterial stiffness. Methods: We used cross-sectional data from 819 individuals aged 50–70 years. B-mode ultrasound of the distal common carotid arteries was performed to determine maximum carotid intima-media thickness, mean carotid intima-media thickness and distension. Results: Carotid intima-media thickness and distension did not differ across homocysteine, serum folate, vitamin B 6 and vitamin B 12 quartiles or between MTHFR C677T genotype. Erythrocyte folate was independently associated with maximum carotid intima-media thickness (mean difference first versus third quartile, 0.03mm, 95% CI 0.004–0.06mm; first versus fourth quartile, 0.03mm, 95% CI −0.002 to 0.06mm). Further adjustment for homocysteine did not affect this association. Folate deficient subjects had greater maximum carotid intima-media thickness than those with high-normal folate concentrations (serum folate: mean difference 0.05mm, 95% CI 0.01–0.08mm; erythrocyte folate: mean difference 0.04mm, 95% CI −0.03 to 0.11mm). Conclusion: Low folate concentrations, independent of hyperhomocysteinemia, may promote atherogenesis. Our findings confirm the null association of homocysteine with carotid intima-media thickness observed in other population-based studies, suggesting that hyperhomocysteinemia does not perpetuate atherosclerosis or arterial stiffness.

Background: Ghrelin plays an important role in the regulation of food intake. Little is known about how ghrelin concentrations are modified by dietary factors. Objective: We examined the effects of both amount and type of carbohydrate on ghrelin concentrations and all correlations among the variables ghrelin, glucose, insulin, leptin, and all 4 subjective measures of appetite. Design: Twenty healthy nonobese men were studied in a double-blind, randomized, crossover design. Subjective measures of appetite and concentrations of ghrelin, glucose, insulin, and leptin were frequently assessed for 4 h after liquid breakfast meals differing in energy content and carbohydrate structure-ie, water, low-calorie (LC) meal, high-calorie simple carbohydrate (HC-SC) meal, and high-calorie complex carbohydrate (HC-CC) meal. Results: Ghrelin concentrations decreased after the HC-SC breakfast by 41%, after the HC-CC breakfast by 33%, and after the LC breakfast by 24%. No significant differences in ghrelin concentration among the 3 breakfasts were observed until 120 min. Ghrelin concentrations were correlated with subjective measures of hunger (r = 0.51) and fullness (r = -0.44). The percentage decrease in ghrelin between 0 and 30 min was inversely correlated with the percentage increases in insulin (r = -0.76) and glucose (r= -0.79) but not with changes in leptin (r = 0.10). The percentage changes in ghrelin concentrations between 30 and 180 min were correlated with the percentage changes in insulin (r= -0.53) and leptin (r= -0.47) but not with changes in glucose (r = 0.22). Conclusion: The results support the hypothesis that ghrelin requires postgastric feedback, which may be regulated through insulin. © 2005 American Society for Clinical Nutrition.

Chromium intake may increase insulin sensitivity, glucose tolerance, and the ratio of high density lipoprotein cholesterol to low density lipoprotein cholesterol. However, the epidemiologic evidence on the association between chromium and cardiovascular disease is very limited. To determine whether low toenail chromium concentrations were associated with risk of nonfatal myocardial infarction, the authors conducted an incident, population-based, case-control study in eight European countries and Israel in 1991-1992. Cases (n = 684) were men with a first diagnosis of myocardial infarction recruited from the coronary units of participating hospitals. Controls (n = 724) were men selected randomly from population registers (five study centers) or through other sources, such as hospitalized patients (three centers), general practitioners' practices (one center), or relatives or friends of cases (one center). Toenail chromium concentration was assessed by neutron activation analysis. Average toenail chromium concentrations were 1.10 mug/g in cases (95% confidence interval: 1.01, 1.18) and 1.30 mug/g in controls (95% CI: 1.21, 1.40). Multivariate odds ratios for quintiles 2-5 were 0.82 (95% CI: 0.52, 1.31), 0.68 (95% CI: 0.43, 1.08), 0.60 (95% CI: 0.37, 0.97), and 0.59 (95% CI: 0.37, 0.95). Toenail chromium concentration was inversely associated with the risk of a first myocardial infarction in men. These results add to an increasing body of evidence that points to the importance of chromium for cardiovascular health.

Adding prebiotics or probiotics to infant formula to improve the intestinal flora of formula-fed infants is considered to be a major innovation. Several companies have brought relevant formulations onto the market. However, comparative data on the effects of pre- and probiotics on the intestinal microflora of infants are not available. The present study aimed to compare the effects of infant formula containing a mixture of galacto- and fructo-oligosaccharides or viableBifidobacterium animalison the composition and metabolic activity of the intestinal microflora. Before birth, infants were randomised and double blindly allocated to one of three formulas. The prebiotic (GOS/FOS) group (n19) received regular infant formula supplemented with a mixture of galacto-oligosaccharides and fructo-oligosaccharides (6g/l). The probiotic (Bb-12) group (n19) received the same formula supplemented with 6·0×1010viable cells ofB. animalisper litre. The standard group (n19) received non-supplemented regular formula. A group of sixty-three breast-fed infants was included as a reference group. Faecal samples were taken at postnatal day 5 and 10, and week 4, 8, 12 and 16. Compared with the groups fed Bb-12 and standard formula, the GOS/FOS formula group showed higher faecal acetate ratio (69·7% (sem 2·7), 69·9% (sem 3·9) and 82·2% (sem 5·3);PP

The recommendation for fruit and vegetable intake includes eating a certain quantity as well as a variety. The evidence for eating a variety is limited. We examined the association with cancer in a prospective cohort study among 730 Dutch men aged 65-84 yr followed for 10 years, resulting in 138 cancer cases. The quantity of fruits and vegetables was assessed using a dietary history and the variety in intake was based on a food frequency questionnaire. Adherence to the recommended amounts of fruit and vegetables was inversely associated with total cancer risk: The adjusted relative risk (RR) was 0.56 [95% confidence interval (CI) = 0.31-1.00]. Eating the recommended daily 200 g of vegetables was not related to cancer incidence, whereas eating the recommended 200 g of fruit was associated with a 38% lower risk. Variety in vegetable intake was inversely associated with total cancer and non-lung epithelial cancer: The RRs (95% CI) for the highest and lowest tertiles were 0.64 (0.43-0.95) and 0.51 (0.27-0.97), respectively. Only after excluding the first two years of follow-up, variety in fruit intake was associated with reduced cancer risk. In conclusion, adherence to the guidelines for fruit and vegetable intake was associated with lower cancer risk. Besides quantity, variety in intake is also of importance.

Background: Aflatoxins and hepatitis B virus (HBV) infections are important risk factors of hepatocellular carcinoma (HCC). This study assesses the population-attributable risk of these two factors, both jointly and separately, with respect to HCC. Methods: A case-control study was conducted in Sudan between 1996 and 1998. Among 114 cases and 198 controls the consumption of peanut butter (a major source of aflatoxins) and HBV infection were investigated, as were drinking and smoking habits. Results: A clear dose-response relation was observed between increasing peanut butter consumption and HCC in people without HBV infection. Age-adjusted odds ratios for peanut butter consumption, HBV infection, and for the combination of both factors were, respectively, 5.1 (95% confidence interval = 1.8-13.9), 32.2 (4.0-257), and 41.5 (11.2-155). In this study, about 80% of the HCC cases are attributable to either peanut butter consumption or HBV infection. Depending on assumptions in the data analysis, 27-60% of all cases can be attributed to aflatoxin exposure and 49-52% to HBV infection; of these figures, 7-34% reflect a shared responsibility of the two factors. Conclusions: Both reduction of aflatoxin contamination of foods and HBV vaccination may be useful public health strategies in HCC prevention in Sudan.

Background: The bioavailability of dietary folate has been estimated to be approximate to50% of that of synthetic folic acid. Folate in the diet is linked to a polyglutamate chain that may restrict folate absorption. Objective: Our goal was to quantify the bioavailability and bioefficacy of low doses of polyglutamyl folic acid relative to that of monoglutamyl folic acid. Design: In total, 180 men and women aged 50-75 y ingested capsules containing 323 nmol heptaglutamyl folic acid/d or 262 nmol monoglutamyl folic acid/d or placebo in a randomized parallel trial. Serum and erythrocyte folate and plasma homocysteine concentrations were measured after an overnight fast at baseline and after 12 wk of intervention. Results: Mean serum and erythrocyte folate concentrations increased less in the polyglutamyl folic acid group [6.1 (95% CI: 5.3, 7.0) and 155 (122, 188) nmol/L, respectively] than in the monoglutamyl folic acid group [ 11.8 (10.3, 13.3) and 282 (246, 318) nmol/L, respectively]. Differences remained statistically significant (P

Increased body weight is a strong risk factor for hypertension. A meta-analysis of randomized controlled trials was performed to estimate the effect of weight reduction on blood pressure overall and in population subgroups. Twenty-five randomized, controlled trials (comprising 34 strata) published between 1966 and 2002 with a total of 4874 participants were included. A random-effects model was used to account for heterogeneity among trials. A net weight reduction of −5.1 kg (95% confidence interval [CI], −6.03 to −4.25) by means of energy restriction, increased physical activity, or both reduced systolic blood pressure by −4.44 mm Hg (95% CI, −5.93 to −2.95) and diastolic blood pressure by −3.57 mm Hg (95% CI, −4.88 to −2.25). Blood pressure reductions were −1.05 mm Hg (95% CI, −1.43 to −0.66) systolic and −0.92 mm Hg (95% CI, −1.28 to −0.55) diastolic when expressed per kilogram of weight loss. As expected, significantly larger blood pressure reductions were observed in populations with an average weight loss >5 kg than in populations with less weight loss, both for systolic (−6.63 mm Hg [95% CI, −8.43 to −4.82] vs −2.70 mm Hg [95% CI, −4.59 to −0.81]) and diastolic (−5.12 mm Hg [95% CI, −6.48 to −3.75] vs −2.01 mm Hg [95% CI, −3.47 to −0.54]) blood pressure. The effect on diastolic blood pressure was significantly larger in populations taking antihypertensive drugs than in untreated populations (−5.31 mm Hg [95% CI, −6.64 to −3.99] vs −2.91 mm Hg [95% CI, −3.66 to −2.16]). This meta-analysis clearly shows that weight loss is important for the prevention and treatment of hypertension.

The objective of the study was to assess the blood pressure response to changes in sodium and potassium intake and examine effect modification by age, gender, blood pressure, body weight and habitual sodium and potassium intake. Randomised trials of sodium reduction or potassium supplementation and blood pressure were identified through reference lists of systematic reviews and an additional MEDLINE search (January 1995–March 2001). A total of 40 sodium trials and 27 potassium trials in adults with a minimum duration of 2 weeks were selected for analysis. Data on changes in electrolyte intake and blood pressure during intervention were collected, as well as data on mean age, gender, body weight, initial electrolyte intake and initial blood pressure of the trial populations. Blood pressure effects of changes in electrolyte intake were assessed by weighted metaregression analysis, overall and in strata of trial population characteristics. Analyses were repeated with adjustment for potential confounders. Sodium reduction (median: −77 mmol/24 h) was associated with a change of −2.54 mmHg (95% CI: −3.16, −1.92) in systolic blood pressure and −1.96 mmHg (−2.41, −1.51) in diastolic blood pressure. Corresponding values for increased potassium intake (median: 44 mmol/24 h) were −2.42 mmHg (−3.75, −1.08) and −1.57 mmHg (–2.65, –0.50). Blood pressure response was larger in hypertensives than normotensives, both for sodium (systolic: −5.24 vs −1.26 mmHg, P

Cigarette smoke contains polycyclic hydrocarbons and arylamines that may both be activated by sulfotransferase, encoded by SULT1A1. A genetic polymorphism leads to an Arg213His substitution, thereby decreasing enzyme activity and stability and might thus modify the association between smoking and colorectal adenomas. We investigated this in a Dutch case-control study. Additionally, we evaluated potential roles of epoxide hydrolase (EPHX), N-acetyltransferases (NAT1 and NAT2) and glutathione S-transferases (GSTM1 and GSTT1). The data analysis included 431 adenoma cases and 432 polyp-free controls (54% women; mean age, 54.6 years) enrolled at endoscopy in 8 Dutch hospitals between 1997 and 2000. All participants provided data on smoking habits and blood for DNA isolation. Genotyping was performed using appropriate polymerase chain reaction-restriction fragment length polymorphism procedures. Multivariate models included age, sex, endoscopy indication, consumption of snacks and alcohol and, if appropriate, daily smoking dose or smoking duration. Smoking increased colorectal adenoma risk, most importantly by duration. Smoking for more than 25 years more than doubled adenoma risk (OR = 2.4, 95% CI = 1.4–4.1) compared to never smoking. Combinations of SULT1A1 fast sulfation (*1/*1) and of NAT2 slow acetylation with smoking resulted in a 4 times higher risk of adenomas compared to never smokers with other inherited gene variants, although there was no statistically significant effect modification. We found no clear effects of the other genetic polymorphisms on the association between smoking and adenomas. We conclude that smoking increases risk of colorectal adenomas and that SULT1A1 and NAT2 only modestly modify this association. © 2003 Wiley-Liss, Inc.

Background: It has been suggested that mercury, a highly reactive heavy metal with no known physiologic activity, increases the risk of cardiovascular disease. Because fish intake is a major source of exposure to mercury, the mercury content of fish may counteract the beneficial effects of its n-3 fatty acids. Methods: In a case-control study conducted in eight European countries and Israel, we evaluated the joint. association of mercury levels in toenail clippings and docosahexaenoic acid (C22:6n-3, or DHA) levels in adipose tissue with the risk of a first myocardial infarction among men. The patients were 684 men with a first diagnosis of myocardial infarction. The controls were 724 men selected to be representative of the same populations. Results: The average toenail mercury level in controls was 0.25 μg per gram. After adjustment for the DHA level and coronary risk factors, the mercury levels in the patients were 15 percent higher than those in controls (95 percent confidence interval, 5 to 25 percent). The risk-factor-adjusted odds ratio for myocardial infarction associated with the highest as compared with the lowest quintile of mercury was 2.16 (95 percent confidence interval, 1.09 to 4.29; P for trend = 0.006). After adjustment for the mercury level, the DHA level was inversely associated with the risk of myocardial infarction (odds ratio for the highest vs. the lowest quintile, 0.59; 95 percent confidence interval, 0.30 to 1.19; P for trend = 0.02). Conclusions: The toenail mercury level was directly associated with the risk of myocardial infarction, and the adipose-tissue DHA level was inversely associated with the risk. High mercury content may diminish the cardioprotective effect of fish intake.

Objective: We evaluated the effect of meat consumption and cigarette smoking in combination with N-acetyltransferases 1 and 2 (NAT1 and NAT2), and glutathione S-transferase M1 (GSTM1) genotypes on colorectal cancer. Methods: From a Dutch prospective study, after 8.5 years of follow-up, data of 102 incident colorectal cancer cases and a random sample of 537 controls frequency-matched for gender and age were analyzed. Baseline information on dietary and smoking habits, as well as blood samples for DNA isolation and genotyping, were available. Results: Red meat intake increased colorectal cancer risk among men (OR 2.7; 95% CI 1.1–6.7 highest vs. lowest intake), whereas poultry and fish decreased risk among women (OR 0.5; 95% CI 0.2–1.07). Cigarette smoking for at least 16 years increased colorectal cancer risk among former smokers only (OR 2.7; 95% CI 1.0–7.4), compared to those having smoked for 15 years or less. NAT1 and NAT2 polymorphisms did not significantly modify these associations. High consumption of poultry and fish was inversely associated with colorectal cancer only in the presence of GSTM1. Conclusions: In this study meat consumption and former long-term smoking were associated with colorectal cancer. Associations of colorectal cancer with different types of meat were modified by gender and GSTM1 genotype.

Background To identify risk factors, associations between dietary patterns, body mass index (BMI), and hypertension in a Chinese population. Methods Dietary intake was assessed in 2518 adults by a 3-day 24 h recall and a food frequency questionnaire. Salt and oil intake was assessed by weighing records. Four dietary patterns were identified using principal component analysis. Overweight and obesity was determined according to the Chinese cut-offs for BMI. High blood pressure was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Prevalence ratios (PR) were calculated using Poisson regression. Results Of the subjects, 26.7% had high blood pressure. Subjects with overweight and obesity were more likely to have high blood pressure than those with normal weight (PR, 95% CI: 1.60, 1.40-1.87; 2.45, 2.11-2.85, respectively). Subjects with a ‘traditional’ dietary pattern were more likely to have high blood pressure (P for trend = 0.001), whereas those with a ‘macho’ or ‘sweet tooth’ dietary pattern were less likely to have high blood pressure (P for trend = 0.004 and 9 g/d, and blood pressure increased with salt intake (P for trend

Background: Data on the relation between alpha-linolenic acid intake and coronary artery disease (CAD) are limited. Other dietary components appear to modify the reported relation between alpha-linolenic acid intake and CAD. Objective: We examined whether dietary alpha-linolenic acid intake was inversely associated with risk of CAD. Design: We prospectively studied 667 men aged 64–84 y from the Zutphen Elderly Study who were free of CAD at baseline. Dietary intake was assessed by using a cross-check dietary history method. Results: During the 10-y follow-up, we documented 98 cases of CAD. After adjustment for age, standard coronary risk factors, and intake of trans fatty acids and other nutrients, _-linolenic acid intake was not significantly associated with CAD risk. The relative risk of CAD for the highest compared with the lowest tertile of alpha-linolenic acid intake was 1.68 (95% CI: 0.86, 3.29). alpha-Linolenic acid intake from sources containing trans fatty acids was also nonsignificantly, yet positively, associated with CAD risk. alpha-Linolenic acid intake from foods that did not contain trans fatty acids was not associated with CAD risk, the relative risk of CAD for the highest compared with the lowest tertile was 1.15 (95% CI: 0.63, 2.11). Conclusion: We did not observe a beneficial effect of dietary alpha-linolenic acid intake on the risk of 10-y CAD incidence. Investigating this hypothesis was complicated by the association between intakes of alpha-linolenic acid and trans fatty acids. Given the results of current prospective studies, a protective cardiac effect of alpha-linolenic acid is questionable.

Item does not contain fulltext BACKGROUND: Frail elders are at risk of suboptimal micronutrient status, functional decline, and neurologic disorders. The influence of oral multimicronutrients in physiologic doses and of moderately intense physical exercise on homocysteine (Hcy), methylmalonic acid (MMA), and neurologic functioning have not yet been investigated. OBJECTIVE: Our goal was to determine the effects of enriched foods and exercise on blood vitamins, Hcy, MMA, and neuropsychological functioning in the frail. DESIGN: A 17-wk randomized controlled intervention trial was used to study 1) enriched foods plus a social program, 2) regular foods plus exercise, 3) enriched foods plus exercise, and 4) regular foods plus a social program. Enriched foods contained multiple micronutrients (25-100% of the Dutch recommended dietary allowances); exercises focused on strength, coordination, flexibility, and endurance. Vitamin (cobalamin, red blood cell folate, and pyridoxal 5'-phosphate), Hcy, and MMA concentrations were measured and 2 neuropsychological tests were conducted. RESULTS: Vitamin concentrations were higher in the supplemented groups than in the unsupplemented groups (P < 0.001; total n = 130). Compared with baseline, cobalamin in the supplemented groups was increased by 22%, plasma folate by 101%, red blood cell folate by 87%, and pyridoxal 5'-phosphate by 68%. Concentrations in the unsupplemented groups changed by -2%, -6%, 1%, and -13%, respectively. Hcy decreased by 25% and MMA by 30% in the supplemented groups, compared with a small increase in Hcy (2%) and decrease in MMA (9%) in the unsupplemented groups. Exercise did not significantly affect vitamin, Hcy, or MMA concentrations. No significant effect of either intervention was observed on the neuropsychological tests. CONCLUSIONS: The decrease in Hcy and MMA in frail elders confirms a subclinical metabolic deficiency state. Enriched foods containing physiologic amounts of micronutrients have a beneficial effect on these metabolites. No effects of B vitamins on mental health were identified.

Background: Serum transferrin receptor concentrations indicate both erythropoietic activity and the deficit of functional iron in the erythron. In contrast with serum ferritin concentrations, serum transferrin receptor concentrations are not or are only marginally influenced by the inflammatory response to infection. Objective: We assessed iron status and examined the relation between serum transferrin receptor concentrations and malaria in children aged 2-36 mo who were asymptomatic for malaria. Design: This was a community-based cluster survey (n = 318). Results: Prevalences of malaria, anemia (hemoglobin concentration

24-Hour Heart Rate Variability in Shift Workers: Impact of Shift Schedule: L.G.P.M. van AMELSVOORT, et al. Department of Epidemiology, Maastricht University—Disturbance of the circadian pattern of cardiac autonomic control by working at night when the physiological system anticipates rest could explain part of the elevated cardiovascular risk in shift workers. Analysis of Heart Rate Variability (HRV) is a non-invasive tool to estimate disturbances of the cardiac autonomic control. To assess the influence of working at night on cardiac autonomic control, HRV levels were determined in shift workers. 24-h ECG recordings were made during a day on morning shift and a day on night shift. Within person differences between a morning and a night shift were calculated. Possible modification of the reported effects by the shift schedule was determined. Significantly elevated mean %LF during sleep was found on a day worked on night shift compared with a day on day shift (%LF + 3.04, P< 0.01). Type of shift schedule was found to be a significant modifier of this effect. The difference in %LF between the night and day shift for the different shift schedules apart were: + 0.88% for the workers in the fast forward rotating shift, + 3.06% for the fast backward rotating shift, + 6.15% (P< 0.001) for the medium speed backward rotating shift and + 1.18% for the shift workers without a regular shift schedule. The results suggest an increased sympathetic dominance during a night shift sleep, indicating an inferior sleep quality. Optimisation of this schedule might diminish this impact and could contribute to a reduction of the cardiovascular disease risk among shift workers. (J Occup Health 2001; 43: 32-38)

To evaluate the effect of fruit and vegetables consumption on markers of risk for cardiovascular disease.Randomised, diet controlled, parallel study.Forty-eight apparently healthy (40--60 y) volunteers with a low usual consumption of fruit and vegetables. Forty-seven of them completed the study.During 4 weeks 24 volunteers consumed a standardised meal, consisting of 500 g/day fruit and vegetables and 200 ml/day fruit juice ('high' group) and 23 volunteers consumed 100 g/day fruit and vegetables ('low' group) with an energy and fat controlled diet.Final total cholesterol was 0.2 (95% CI -0.5--0.03) mmol/l lower in the high group than in the low group (P0.05). Final fibrinogen and systolic blood pressure were 0.1 (-0.1--0.4) g/l and 2.8 (-2.6--8.1) mmHg higher in the high group than in the low group (P0.05), respectively. Also, other final serum lipid concentrations, diastolic blood pressure and other haemostatic factors did not differ between both groups.This was a small randomised well-controlled dietary intervention trial of short duration with a considerable contrast in fruit and vegetable consumption. No effects on serum lipids, blood pressure and haemostatic variables were observed.

Objective: Hepatocellular carcinoma (HCC) is one of the major cancers in the world. In Sudan the incidence is thought to be high and increasing. This study aims to assess the association between peanut butter intake, as a source of aflatoxins, and the GSTM1 genotype in the etiology of HCC. Method: A case–control study was conducted among 150 patients and 205 controls from two regions in Sudan. Food habits with special reference to peanut butter consumption, as well as peanut storage systems, have been investigated, as well as confounders such as hepatitis, drinking and smoking habits, and demographic characteristics. GSTM1 genotype was assessed in DNA extracted from blood samples (110 cases, 189 controls). Results: A positive association was observed for highest vs. lowest quartile of peanut butter intake, humid storage system and HCC, with ORs (95% CI) being 3.0 (1.6–5.5) and 1.6 (1.1–2.5) respectively. The positive association with peanut butter intake was essentially limited to subjects with GSTM1 null genotype with OR for highest vs. lowest quartile 16.7 (2.7–105). Conclusion: Peanut butter consumption has been identified as a strong risk factor of HCC in a region with endemic aflatoxin contamination in Sudan and was essentially limited to subjects with the GSTM1 null genotype.

ObjectiveWe quantified the public health benefit of fruits and vegetables on the prevention of cancer and cardiovascular disease (CVD), using currently available human data.DesignWe reviewed over 250 observational studies on cancer and CVD. Relative risks (RRs) for high versus low intake of fruits and vegetables were obtained. The preventable proportion of chronic diseases, i.e. the per cent of cases attributable to low consumption of fruits and vegetables, was estimated using three scenarios: best guess, optimistic (using stronger RRs) and conservative (using weaker RRs and eliminating the contribution of smoking and/or drinking). The preventable proportion was calculated for increasing average intake from the current 250 g day−1 to the recommended 400 g day among the general Dutch population.ResultsIt is estimated that in the Netherlands cancer incidence could be reduced by 19% (12 000 cases annually, best guess), ranging from 6% (conservative) to 28% (optimistic). Cardiovascular deaths could be reduced by 16% (8000 deaths annually, best guess), ranging from 6% to 22%. Evidence is most abundant for gastrointestinal cancers, followed by hormone-related cancers, but limited for other sites and CVD.ConclusionsIncreasing consumption of fruits and vegetables carries a large public health potential. Population trials and biological mechanisms should eventually provide scientific proof of their efficacy. The available evidence is sufficient to justify public health education and promotion aimed at a substantial increase in the consumption of fruits and vegetables.

K-ras and p53 gene mutations are known to occur in high frequencies in sporadic colorectal cancers, but findings are inconsistent in hereditary nonpolyposis colorectal cancer (HNPCC). We compared K-ras codon 12 and 13 gene mutations and p53 protein overexpression in 48 HNPCC (positive for Amsterdam criteria) and 59 sporadic colorectal adenomas, to examine whether they may represent similar or different molecular pathways to cancer. In sporadic adenomas K-ras mutations were detected in 32% and p53 overexpression in 31% of the cases. Similarly, K-ras mutations and p53 overexpression were both found in 25% of HNPCC adenomas. The frequencies of these abnormalities were not significantly different between HNPCC and sporadic adenomas. When taking differences in adenoma size into account, the frequencies were even more similar. In conclusion, these results suggest a similar molecular pathway to adenomas in HNPCC and sporadic carcinogenesis, with respect to involvement of K-ras and p53.

Conditioning is an important mechanism for establishing food preferences. Although the basic principles for conditioning are well-known, less is known about the conditions under which this type of learning takes place. This paper aims to add to the knowledge of the essential conditions for flavour–nutrient learning with vegetable flavours. We describe a study which aimed to investigate whether flavour–nutrient learning is effective in increasing 7–8-year-old children's preference for vegetables. Their preference for, and consumption of, two different vegetable drinks was measured before and after a 14-day-conditioning period, using a within-subject design. Flavour–nutrient learning could not occur, due to insufficient consumption during the conditioning period: 2.4 g (S.D. = 5.6) for the high energy (HE) drink and 3.0 g (S.D. = 9.3) for the low energy (LE) drink. The high taste intensity may have caused the insufficient consumption. We hypothesize that the pure taste of vegetables in itself is not acceptable. Mixing vegetables with other foods may lead to gradual acceptance of vegetables through flavour–flavour and flavour–nutrient learning. Future flavour–nutrient learning studies with children should use less intense vegetable flavours.

Plant foods are generally considered to be beneficial for health. A higher consumption of fruits, and to a lesser extent vegetables, is consistently associated with a lower risk of stomach cancer. Results on the association between stomach cancer and grain consumption are less clear. We associated plant food consumption with 25-year stomach cancer mortality at population level in the Seven Countries Study. Around 1960, > 12,000 men aged 40-59 years from 7 countries and 16 cohorts were enrolled. In each cohort, dietary information was collected in small random samples. Crude and adjusted associations were calculated for a change of 10% of mean intake. Results differed for the plant foods studied: an inverse association was observed for fruits (adjusted rate ratio = 0.96, 95% confidence interval = 0.91-0.99), a positive relation for refined grains (adjusted rate ratio = 1.07, 95% confidence interval = 1.03-1.12), and no association for total plant foods, vegetables, whole grains, and potatoes. A high intake of refined grains was correlated with a low consumption of fruits. In conclusion, high intake of refined grains may increase stomach cancer risk. However, because adjustment could only be limited in this study, high intake of refined grains may just reflect the deleterious effect of a diet low in fruits or other characteristics associated with low fruit consumption.

Many observational studies have found that higher consumption of vegetables, and to a lesser extent of fruits, was associated with lower risk of colorectal cancer. In particular, fiber or foods high in fiber have received attention in the potential prevention of colorectal cancer. We performed an ecological analysis with data of the Seven Countries Study, to investigate whether intake of fiber and plant foods contributes to cross-cultural differences in 25-year colorectal-cancer mortality in men. In the Seven Countries Study, around 1960 12,763 men aged 40 to 59 were enrolled in 16 cohorts in 7 countries. Baseline dietary information was gathered in small random samples per cohort, and nutrient intakes were based on chemical analyses of the average diets per cohort. Crude and energy-adjusted mortality-rate ratios were calculated for a change of 10% of the mean intake of fiber and plant foods, i.e., total plant foods, fruits, vegetables, potatoes, grains, and related sub-groups. Fiber intake was inversely associated with colorectal-cancer mortality with an energy-adjusted rate ratio of 0.89 (95% confidence interval 0.80-0.97). An increase of 10 gram of daily intake of fiber was associated with a 33% lower 25-year colorectal-cancer mortality risk. Intakes of vitamin B6 [0.84 (0.71-0.99)] and alpha-tocopherol [0.94 (0.89-0.99)] were also inversely associated with risk. Consumption of plant foods and related sub-groups was not related to colorectal cancer. It appears that fiber intake best indicates the part of plant food consumption, including whole grains, that is relevant for lowering colorectal cancer risk.

OBJECTIVE: An elevated cardiovascular disease risk for shiftworkers has frequently been reported, however, the mechanism is still unknown. Changes in eating habits, in physical activity or metabolic factors could be involved. In this study we assessed the relationship between body mass index (BMI) as a possible indicator of changed eating habits or metabolic involvement and duration of shiftwork. DESIGN: Data from an ongoing cohort study among 377 shiftworkers and non-shiftworking controls, all starting in a new job were used. Anthropometric measurements were carried out at the start of the assignment. Job history was obtained by a questionnaire. RESULTS: A positive relationship was observed between BMI and waist to hip ratio (WHR) and duration of shiftwork experience, with an adjustment for age. The linear regression coefficients, with additional adjustments for sex, smoking status, physical activity and educational level were 0.12 kg/m2 per y in shiftwork for BMI (P

Department of Epidemiology and Public Health, Wageningen University, The Netherlands.OBJECTIVE: To investigate the effect of a six-months training program on changes in body weight and lipid concentrations, and their interrelationship in elderly people. DESIGN: Intervention study. The elderly subjects were randomly assigned to a control group or one of two supervised aerobic training groups, either all round activities or ergometer cycling, both exercising 3-4 times a week for six months. SUBJECTS: 229 elderly men and women, aged 60-80 y. MEASUREMENTS: Various fatness parameters by anthropometry, serum lipids and peak power output. RESULTS: During the intervention, no significant changes were observed in weight or body fatness in subjects of the training groups. Serum high density lipoprotein (HDL), low density lipoprotein (LDL) and total cholesterol and triglycerides tended to change in a favourable direction in the elderly of the intervention groups, but only triglyceride concentration in women of the cycle ergometer group (mean difference with controls: -0.24 mmol/L, 95% confidence interval (CI): -0.45, -0.03) and total serum cholesterol and HDL-cholesterol concentrations in subjects of the all-round activity group, (-0.32mmol/L, 95% CI: -0.63, -0.01 and -0.15mmol/L, 95% CI -0.25, -0.05, respectively) were significantly reduced as compared to controls. Regression analysis showed that the intervention-control difference in change of all lipids was independent of changes in weight, body fat and previous engagement in sport activity. CONCLUSION: Regular physical exercise in an elderly population resulted in favourable changes in serum lipid concentrations that were not significant, but no change in body weight or fatness. Change in lipid concentration could not be attributed to change in weight or body fat.Publication Types: Clinical Trial Randomized Controlled Trial

Abstract Epidemiological research has shown that elevated plasma total homocysteine (tHcy) is a risk factor for atherosclerotic disease. In the present case-control study, we investigated whether fasting or postmethionine-loading tHcy was a stronger predictor of risk of severe coronary atherosclerosis. Furthermore, we studied levels of B vitamins, which are involved in homocysteine metabolism. Subjects were recruited from men and women, aged 25 to 65 years, who underwent coronary angiography between June 1992 and June 1994 in a hospital in Rotterdam, The Netherlands. Cases (n=131) were defined as those with ≥90% occlusion in one and ≥40% occlusion in a second coronary artery, while control subjects (n=88) had ≤50% occlusion in only one coronary vessel. In addition, a population-based control group free from clinical cardiovascular disease (n=101) was studied. Coronary patients were studied at least 2.5 months after angiography or other acute illness, such as myocardial infarction. After adjusting for age and sex differences between the groups, cases had 9% ( P =.01) higher geometric mean fasting and 7% ( P =.04) higher geometric mean postload tHcy than the combined control groups. Despite higher levels of tHcy for cases, their geometric mean levels of red cell folate and pyridoxal 5′-phosphate were higher than for control subjects, whereas plasma vitamin B 12 was only slightly lower in cases. The frequency distribution of tHcy values in cases was slightly shifted toward the right, across the entire range, compared with the distribution in the combined control group. This was somewhat more obvious for fasting than postload tHcy levels. The odds ratio (OR) for severe coronary atherosclerosis (case status) for each 1 SD increase in fasting tHcy (5 μmol/L) was 1.3 (95% confidence interval [CI], 1.0-1.6), similar to the OR for each 1 SD increase (12 μmol/L) in postmethionine-loading tHcy (1.3 [95 CI, 1.0-1.7]), after adjustment for sex, age, and other potential confounders. Furthermore, there was a significant linear trend of increasing fasting tHcy with increasing number of occluded arteries ( P =.01), correcting for sex, age, and other potential confounders. Our data show a positive association between plasma tHcy and risk of severe coronary atherosclerosis, of similar strength for fasting and postload tHcy levels. The data suggest that the association exists over a wide range of tHcy levels, without a clear cutoff point below which there is no increased risk.