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Observational studies of dietary patterns and growth and studies with milk supplementation have shown that children consuming diets containing animal source foods grow better. This study evaluates the growth of 544 Kenyan schoolchildren (median age 7.1 y) after 23 mo of food supplementation with a meat, milk or energy supplement (~1255 kJ) compared to a control group without a supplement. Multivariate analyses controlled for covariates compared gain in weight, height, weight-for-height Z-score (WHZ), height-for-age Z-score (HAZ), mid-upper-arm circumference, triceps and subscapular skinfolds, mid-upper-arm muscle and mid-upper-arm fat area. Children in each of the supplementation groups gained ~0.4 kg (10%) more weight than children in the Control group. Children in the Meat, Milk and Energy groups gained 0.33, 0.19 and 0.27 cm more, respectively, in mid-upper-arm circumference than children in the Control group. Children who received the Meat supplement gained 30-80% more mid-upper-arm muscle area than children in the other groups, and children who received the milk supplement gained 40% more mid-upper-arm muscle area than children who did not receive a supplement. No statistically significant overall effects of supplementation were found on height, HAZ, WHZ or measures of body fat. A positive effect of the milk supplement on height gain could be seen in the subgroup of children with a lower baseline HAZ ([is less than or equal to]-1.4). The results indicate that food supplements had a positive impact on weight gain in the study children and that the addition of meat increased their lean body mass. KEY WORDS: * animal source foods * growth * body composition * schoolchildren * Kenya

Animal source foods can provide a variety of micronutrients that are difficult to obtain in adequate quantities from plant source foods alone. In the 1980s, the Nutrition Collaborative Research Support Program identified six micronutrients that were particularly low in the primarily vegetarian diets of schoolchildren in rural Egypt, Kenya and Mexico: vitamin A, vitamin B-12, riboflavin, calcium, iron and zinc. Negative health outcomes associated with inadequate intake of these nutrients include anemia, poor growth, rickets, impaired cognitive performance, blindness, neuromuscular deficits and eventually, death. Animal source foods are particularly rich sources of all six of these nutrients, and relatively small amounts of these foods, added to a vegetarian diet, can substantially increase nutrient adequacy. Snacks designed for Kenyan schoolchildren provided more nutrients when animal and plant foods were combined. A snack that provided only 20% of a child's energy requirement could provide 38% of the calcium, 83% of the vitamin B-12 and 82% of the riboflavin requirements if milk was included. A similar snack that included ground beef rather than milk provided 86% of the zinc and 106% of the vitamin B-12 requirements, as well as 26% of the iron requirement. Food guides usually recommend several daily servings from animal source food groups (dairy products and meat or meat alternatives). An index that estimates nutrient adequacy based on adherence to such food guide recommendations may provide a useful method of quickly evaluating dietary quality in both developing and developed countries. KEY WORDS: * animal source foods * schoolers * dietary quality * micronutrients

Dietary Reference Intakes (DRIs) are now available for energy, macronutrients, fiber, vitamins, and minerals, and can be used to plan diets for individuals. This article defines the four DRIs (the Estimated Average Requirement, the Recommended Dietary Allowance, the Adequate Intake, and the Tolerable Upper Intake Level), and describes two other reference standards--the Estimated Energy Requirement and the Acceptable Macronutrient Distribution Range. Planning diets for individuals involves identifying the appropriate nutrient intake goals, translating the nutrient goals into food intake (and supplement use, if warranted), assessing the plan, and revising it if required. This process is illustrated using case studies of a female vegetarian marathon runner and an older male smoker. Key words: diet planning, recommended intakes, energy, macronutrients, vitamins, minerals

The Food Guide Pyramid is designed to help Americans make healthful food choices. Whereas national data have been collected to examine adherence to the pyramid recommendations in whites, African-Americans, and Latinos, there are virtually no data available for Japanese Americans or Native Hawaiians. Here we present data on intakes of the Food Guide Pyramid food groups (as servings per day) as well as of the components of the pyramid tip (discretionary fat, added sugar, and alcohol) in these ethnic groups and examine adherence to each of the food group recommendations. Degree of adherence to the fruit group recommendation was similar among the ethnic groups and energy-intake categories, but adherence to the other recommendations was greatest for those consuming more than 2,800 kilocalories per day. However, subjects in this energy-intake group also consumed more than three times as much discretionary fat, added sugar, and alcohol.

Objective: To report 6 psychometric properties of food behavior checklist (FBC) items and then to use these properties to systematically reduce the number of items on this evaluation tool. Design: Random assignment to the intervention and control groups. Setting: Low-income communities. Participants: Women (N = 132) from limited-resource families. Main Outcome Measures: Reliability, internal consistency, baseline differences by ethnicity, sensitivity to change, and criterion and convergent validity of subscales. Results: The fruit and vegetable subscale showed a significant correlation with serum carotenoid values (r = .44, P < .001), indicating acceptable criterion validity. Milk, fat/cholesterol, diet quality, food security, and fruit/vegetable subscales showed significant correlations with dietary variables. Nineteen items have acceptable reliability. Twenty items showed no baseline differences by ethnic group. Eleven of the 15 items expected to show change following the intervention demonstrated sensitivity to change. Conclusions and Implications: This brief food behavior checklist (16 items) is easy to administer to a client group, has an elementary reading level (fourth grade), and has a low respondent burden in addition to meeting requirements for validity, reliability, and sensitivity to change. This study establishes a process that can be used by other researchers to develop and further refine instruments for use in community health promotion interventions. KEY WORDS: evaluation, food behaviors, Expanded Food and Nutrition Education Program (EFNEP), low income

Intake data from the combined CSFII/NHANES survey will be used for many different purposes, each with specific data requirements and appropriate analytic methods. For monitoring and surveillance, the availability of Dietary Reference Intakes will allow estimates of the prevalence of inadequate intakes and the prevalence of intakes with a risk of adverse effects. The accuracy of the nutrient intake estimates will be enhanced by the 5-pass dietary recall methodology, availability of quantified dietary supplement intake data and expanded food and supplement composition data. Food-level dietary monitoring will be improved by using new databases to calculate servings of food groups from the Food Guide Pyramid and intakes of food commodities. Another major strength of the survey is the ability to relate intake data to health measures for individuals. Inferences will continue to be limited by a lack of usual intake for each individual, but the attenuation will be less with 2 d of data than with only 1 d, as in the past. Better data collection and analysis will also lead to more informed nutrition policies and programs. Innovative methods of analyzing the data should be investigated to minimize the effects of underreporting, provide better estimates of usual intake at both the group and individual levels and accurately combine nutrient intakes from foods and supplements. Future modifications to the intake collection methods might be considered to allow larger sample sizes for certain subgroups, more detailed information on supplement use, an expanded food frequency questionnaire, a different number of recall days and incorporation of diet and health knowledge questions. KEY WORDS: * dietary surveys * dietary assessment * nutrition monitoring * Dietary Reference Intakes

New Dietary Reference Intakes (DRIs) are being set by the Institute of Medicine, and represent a new way of defining nutrient intake recommendations. For the first time, the recommendations for the United States and Canada allow the calculation of the probability of adequacy for an individual, and the prevalence of inadequacy for a population. In addition, possible excessive consumption of many nutrients can be evaluated. The goal of this review is to provide a practical guide to the proper uses of the new DRIs when assessing intakes. Key Words: Dietary Reference Intakes, DRIs, nutrients, assessing intakes

The term Dietary Reference Intakes (DRIs) refers to a set of 4 nutrient-based reference values intended primarily for use in assessing and planning diets. The DRIs, the outcome of the [...]

We report the case of a phosphaturic mesenchymal tumor of the ankle; an extremely rare lesion that causes osteomalacia via paraneoplastic renal phosphate wasting. A 41-year-old man was referred to plastic surgery with a swelling over the anterior ankle, which had been increasing in size for 1 year. Focused ultrasound assessment was inconclusive, but excision biopsy demonstrated features in keeping with a phosphaturic mesenchymal tumor. Evidence of tumor-induced osteomalacia was subsequently identified on review of historical biochemistry. The patient was followed-up for 1 year with normalization of serum phosphate. In this case report, we present a discussion of the differential diagnosis for foot and ankle soft tissue lesions, and a review of the literature regarding the diagnosis and management of these tumors. Accurate identification of any soft tissue lesion on clinical examination alone is extremely challenging and excision biopsy should be considered in cases of diagnostic uncertainty. [ABSTRACT FROM AUTHOR]

The surgical management of cutaneous malignancies has evolved over recent years with the introduction of novel medical therapies and an increasing emphasis upon early adjuvant systemic therapy. As such, completion lymph node dissection (cLND) is now no longer recommended following a positive sentinel lymph node biopsy (SLNB) in melanoma. We evaluated our ten-year practice at a regional tertiary centre, assessing the change in lymph node dissection (LND) caseload volume, anatomical distribution, and indication for the procedure. A retrospective search was carried out of all LNDs performed by the Plastic Surgery department at Cambridge University Hospitals NHS Trust, UK from 1 January 2010 to 31 December 2019. Case notes were retrospectively analysed for each procedure, with the site and pathology recorded. A total of 491 LNDs were performed over the 10-year period. Surgical volume peaked in 2015 with 67 cases, followed by a decline to 41 cases in 2019. The number of neck dissections increased over the decade, as well as the proportion of cases due to macroscopic nodal disease. We sub-analysed the number of LNDs in three contiguous 18-month intervals, corresponding to changes in practice due to evidence from the DeCOG and MSLT-II Trials. We found a 41.67% reduction in LNDs caseload between July 2018-Dec 2019, compared to a similar period prior to trial evidence (July 2015-Dec 2016) (p=0.0.14). In summary, the surgical volume of LNDs has decreased significantly since 2018, reflecting emerging evidence and changes to national guidelines. This will require ongoing monitoring for workforce planning and surgical training. [ABSTRACT FROM AUTHOR]

To develop national nutrition policies, it is necessary to know what Americans are eating and which segments of the population may be at nutritional risk of underconsumption (eg, of micronutrients) [...]

In the United States, the number of elderly who live alone has increased dramatically since 1960 (1). As of 1986, approximately 30% of persons 65 years and older lived alone; [...]

The impact of sociodemographic, health-related, and behavioral variables on the dietary adequacy of the younger old (65 to 84 years, N = 2496) and oldest old (85 years and older, N = 159) was investigated using data from the Nationwide Food Consumption Survey 1977-78. The percent of individuals with poor diets (defined as mean three-day intake below 67% of the 1989 Recommended Dietary Allowances for at least five of the nine nutrients examined) was greater for women (18%) than for men (13%) and for the oldest old (21%) than for the younger old (16%). Better diet quality was associated both with increased quantity and with increased nutrient density of diets. Multivariate analyses identified two factors of importance for nutrient quality for both the younter and oldest old: mean energy intake and percent of calories from ready-to-eat cereal. Positive predictors of energy intake for both age groups included: number of meals, percent of calories from snacks, and money per person spent on food by the household. These results suggest that nutritional guidance for older Americans should focus on maintenance of adequate (but not excessive) energy intakes by consuming three meals a day plys snacks. Selection of foods of high nutrient density, such as fortified ready-to-eat cereals, should be emphasized, particularly when energy intakes are low. Nutrition programs should target individuals at risk of low food intakes: women, the oldest old, and persons in poor health, on weight-loss diets, or with inadequate money for food.