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ABSTRACT Humanity has a longstanding reliance on natural plants for medicinal purposes, and Gymnema lactiferum (G. lactiferum) has emerged as a medicinal plant with deep‐rooted traditional usage. Throughout history, this plant has been an integral part of traditional medical systems, demonstrating diverse therapeutic effects. Notably, among these effects is its ability to decrease blood glucose concentration in diabetic patients, impart cooling effects, serve as an anabolic and rehydrating agent, stimulate spermiogenesis, and exhibit wormicidal properties. Furthermore, G. lactiferum has been used in treating conditions such as hemorrhoids cancers, anorexia, and as a cardiac stimulant. The primary objective of this review is to comprehensively gather and critically assess research findings regarding the medicinal properties of G. lactiferum, specifically emphasizing the bioactive compounds responsible for these properties. Previous studies have documented the presence of various phytochemicals in G. lactiferum, which are associated with some biological activities, including antioxidative, anti‐hyperglycemic, cholesterol‐regulating, and anti‐inflammatory properties. Additionally, this review explores potential future applications for this plant. Beyond its medicinal significance, extracts derived from G. lactiferum demonstrate promise for future nutritional applications. This review highlights the potential use of G. lactiferum as an herbal medicine by critically assessing research on its medicinal value. [ABSTRACT FROM AUTHOR]

Background: In low-income countries, most infants are given cereal-based complementary foods prepared at the household level. Such foods are high in phytate, which limits the bioavailability of nutrients, including iron, calcium, zinc, and in some cases proteins, which are crucial to the development of infants.Objective: To compare the levels of macronutrients (protein, fat, and carbohydrate), gross energy, and fructose in sweet potato-based (denoted ComFa) formulations and enriched Weanimix (dehulled maize-dehulled soybean-groundnut blend with fish powder and sugar incorporated). The phytate level was also compared.Methods: A composite flour of sweet potato and soybeans containing fish powder was processed by oven toasting as a home-based complementary food. Another blend containing skim milk powder was processed by extrusion cooking or roller drying as industrial-based prototypes. The macronutrient composition and the levels of fructose and phytate were determined in the ComFa formulations and enriched Weanimix.Results: The ComFa formulations and the enriched Weanimix met the stipulated values in the Codex Alimentarius Commission standard for energy (400 kcal/100 g), protein (15 g/100 g), and fat (10 to 25 g/100 g) for complementary food, with the exception of the industrial-based ComFa formulations, which satisfied 83% of the protein requirement (15 g/100 g). The ComFa formulations had a quarter of the phytate level of enriched Weanimix. The fructose level in the sweet potato-based complementary foods was more than five times that in enriched Weanimix.Conclusions: The sweet potato-based formulations were superior to enriched Weanimix as complementary foods for infants in low-income countries, based on the fructose (which makes the porridge naturally sweet) and phytate levels. [ABSTRACT FROM AUTHOR]

Poor nutrient intake during pregnancy can adversely affect both infant and maternal health. The aim was to investigate the efficacy of multiple-micronutrient supplementation during pregnancy in a socially deprived population in the developed world. We conducted a randomised, double-blind, placebo-controlled trial of multiple-micronutrient supplementation including 20 mg Fe and 400 microg folic acid, from the first trimester of pregnancy in 402 mothers, in East London, UK. Nutrient status was measured at recruitment, and at 26 and 34 weeks of gestation. Infants were weighed at birth. At recruitment the prevalence of anaemia was 13%, vitamin D insufficiency 72%, thiamin deficiency 12% and folate deficiency 5%, with no differences between groups. Only 39% of women completed the study; rates of non-compliance were similar in both groups. Intention-to-treat analysis showed that participants receiving treatment had higher mean Hb at 26 weeks of gestation (110 (sd 10) v.108 (sd 10) g/l; P = 0.041) and 34 weeks of gestation (113 (sd 12) v.109 (sd 10) g/l; P = 0.003) and packed cell volume concentrations at 26 weeks of gestation (0.330 (sd 0.025) v. 0.323 (sd 0.026) l/l; P = 0.011) and 34 weeks of gestation (0.338 (sd 0.029) v. 0.330 (sd 0.028) l/l; P = 0.014) compared with controls. Analysis of compliant women showed supplemented women had higher median concentrations of serum ferritin, erythrocyte folate and 25-hydroxyvitamin D later in gestation than controls. In the compliant subset (n 149), placebo mothers had more small-for-gestational age (SGA) infants (eight SGA v. thirteen; P = 0.042) than treatment mothers. Baseline micronutrient deficiencies were common; the multiple-micronutrient supplement was well-tolerated and improved nutrient status. Multiple-micronutrient supplements from early pregnancy may be beneficial and larger studies are required to assess impact on birth outcomes and infant development. [ABSTRACT FROM AUTHOR]

Background: The role of folate supplementation in preventing neural tube defects is well known; however, preconception supplement use continues to be low, especially amongst the socially disadvantaged. The present study explored periconception folic acid supplement use in a socially deprived, ethnically diverse population. Methods: Pregnant women (n = 402) in the first trimester of pregnancy were recruited in East London. Using a researcher led questionnaire, details were obtained regarding social class, ethnicity and folic acid use. Red cell folate levels were determined for 367 participants during the first trimester. Results: Although 76% of participants reported using folic acid supplements during the first trimester, only 12% started preconception and a further 17% started before neural tube closure. Mothers from higher social groups or with higher levels of education were more likely to use folic acid and started taking it earlier. Ethnic differences were also seen in preconception usage (Africans, 5%; West Indians, 8%; Asians, 12%; Caucasians, 19%; P = 0.038). Participants who took folic acid supplements had significantly higher mean (SD) red cell folate concentrations than those who took none [936 (*\1.6) and 579 (*\1.6) nmol L)1, respectively; P < 0.001]. Conclusions: Folic acid supplement use preconception and prior to neural tube closure continues to be low, exhibiting both social and ethnic disparities. [ABSTRACT FROM AUTHOR]

Zinc and selenium are essential minerals for human nutrition. Reliable biomarkers of zinc status and selenium status in humans are therefore important. This work investigates a novel portable X-ray fluorescence (XRF) method with the ability to rapidly assess zinc and selenium in nail clippings. This approach used a mono-energetic X-ray beam to excite characteristic X-rays from the clippings. Nail clippings were obtained from the Mother and Infant Nutrition Investigation (MINI), a study designed to assess nutrition in a population of women and their breastfed children in New Zealand. Twenty mother-infant pairings were selected to provide nail clippings at two time points (visit 1 at 3 months postpartum; visit 2 at 6 months postpartum). Nail clippings from each mother-infant pairing were divided into three groupings of clippings prior to analysis: those obtained from a big toe of the mother, those from the other toes of the mother, and those from the toes and fingers of the infant. Clippings were prepared and mounted prior to XRF measurement, providing four distinct fragments from each clipping grouping. These fragments were assessed by XRF using a measurement time of either 300 s (visit 1) or 180 s (visit 2). XRF results were determined through both an automated system output and an analysis of the X-ray energy spectrum. Following this assessment of zinc and selenium with the non-destructive XRF method, clippings were measured for zinc and selenium concentration using a "gold standard" technique of inductively coupled plasma mass spectrometry (ICP-MS). Mean ICP-MS concentrations ranged from 122 μg/g to 127 μg/g for zinc, and from 0.646 μg/g to 0.659 μg/g for selenium. Precision, assessed by a relative standard deviation of measurement, was superior for ICP-MS relative to XRF. For both zinc and selenium, XRF results were compared with ICP-MS concentrations. Linear equations of best fit were determined for each comparison between XRF and ICP-MS results. Coefficients of determination (r2) were stronger for zinc (from 0.74 to 0.95) than selenium (from 0.53 to 0.70). A decrease in XRF measurement time from 300 s to 180 s did not appear to adversely affect the correlation between XRF and ICP-MS results. Using the mono-energetic portable XRF method, the correlation of XRF zinc results with ICP-MS zinc concentrations was improved over previous findings, and selenium measurement was reported for the first time. The method may prove useful for future applications to trace element analysis using nail clippings as a biomarker., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Fleming et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Inadequate antenatal care (ANC) in low-income countries has been identified as a risk factor for poor pregnancy outcome. While many countries, including Rwanda, have near universal ANC coverage, a significant proportion of pregnant women do not achieve the recommended regimen of four ANC visits. The present study aimed to explore the factors associated with achieving the recommendation, with an emphasis on the distance from household to health facilities., Methods: A geo-referenced cross-sectional study was conducted in Rutsiro district, Western province of Rwanda with 360 randomly selected women. Multiple logistic regression analysis including adjusted odd ratio (aOR) were performed to identify factors associated with achieving the recommended four ANC visits., Results: The majority (65.3%) of women had less than four ANC visits during pregnancy. We found a significant and negative association between distance from household to health facility and achieving the recommended four ANC visits. As the distance increased by 1 km, the odds of achieving the four ANC visits decreased by 19% (aOR = 0.81, P = 0.024). The odds of achieving the recommended four ANC visits were nearly two times higher among mothers with secondary education compared with mothers with primary education or less (aOR = 1.90, P = 0.038). In addition, mothers who responded that their household members always seek health care when necessary had 1.7 times higher odds of achieving four ANC visits compared with those who responded as unable to seek health care (aOR = 1.7, P = 0.041). Furthermore, mothers from poor households had 2.1 times lower odds of achieving four ANC visits than mothers from slightly better-off households (aOR = 2.1, P = 0.028)., Conclusions: Findings from the present study suggest that, in Rutsiro district, travel distance to health facility, coupled with socio-economic constraints, including low education and poverty can make it difficult for pregnant women to achieve the recommended ANC regimen. Innovative strategies are needed to decrease distance by bringing ANC services closer to pregnant women and to enhance ANC seeking behaviour. Interventions should also focus on supporting women to attain at least secondary education level as well as to improve the household socioeconomic status of pregnant women, with a particular focus on women from poor households., (© 2023. The Author(s).)

Purpose of Review: Iodine deficiency is a global concern, and in recent years, there has been a significant improvement in the number of countries identified as being iodine-sufficient. This review considers the best strategies to ensure iodine sufficiency among breastfeeding women and their infants., Recent Findings: Fortification strategies to improve iodine intake have been adequate for school-age children (SAC); however, often, iodine deficiency remains for breastfeeding women and their infants. Daily supplementation with iodine is not an ideal strategy to overcome deficiency. Countries defined as iodine-sufficient, but where pregnant and breastfeeding women have inadequate intake, should consider increasing salt iodine concentration, such that the median urinary iodine concentration of SAC can be up to 299 µg/L. This will ensure adequate intake for mothers and infants, without SAC being at risk thyroid dysfunction. Consensus is required for thresholds for iodine adequacy for breastfeeding women and infants., (© 2022. The Author(s).)

To alleviate the re-emergence of iodine deficiency in New Zealand, two strategies, the mandatory fortification of bread with iodised salt (2009) and a government-subsidised iodine supplement for breast-feeding women (2010), were introduced. Few studies have investigated mother and infant iodine status during the first postpartum year; this study aimed to describe iodine status of mothers and infants at 3, 6 and 12 months postpartum (3MPP, 6MPP and 12MPP, respectively). Partitioning of iodine excretion between urine and breast milk of exclusive breast-feeding (EBF) women at 3MPP was determined. In total, eighty-seven mother-infant pairs participated in the study. Maternal and infant spot urinary iodine concentration (UIC) and breast milk iodine concentration (BMIC) were determined. The percentage of women who took iodine-containing supplements decreased from 46 % at 3MPP to 6 % at 12MPP. Maternal median UIC (MUIC) at 3MPP (82 (46, 157) µg/l), 6MPP (85 (43, 134) µg/l) and 12MPP (95 (51, 169) µg/l) were <100 µg/l. The use of iodine-containing supplements increased MUIC and BMIC only at 3MPP. Median BMIC at all time points were below 75 µg/l. Infant MUIC at 3MPP (115 (69, 182) µg/l) and 6MPP (120 (60, 196) µg/l) were below 125 µg/l. Among EBF women at 3MPP, an increased partitioning of iodine into breast milk (highest proportion 60 %) was shown at lower iodine intakes, along with a reduced fractional iodine excretion in urine (lowest proportion 40 %), indicating a protective mechanism for breastfed infants' iodine status. In conclusion, this cohort of postpartum women was iodine-deficient. Iodine status of their breastfed infants was suboptimal. Lactating women who do not consume iodine-rich foods and those who become pregnant again should take iodine-containing supplements.

Maternal dietary micronutrients and omega-3 fatty acids support development of the fetal and neonatal immune system. Whether supplementation is similarly beneficial for the mother during gestation has received limited attention. A scoping review of human trials was conducted looking for evidence of biochemical, genomic, and clinical effects of supplementation on the maternal immune system. The authors explored the literature on PubMed, Cochrane Library, and Web of Science databases from 2010 to the present day using PRISMA-ScR methodology. Full-length human trials in English were searched for using general terms and vitamin A, B12, C, D, and E; choline; iodine; iron; selenium; zinc; and docosahexaenoic/eicosapentaenoic acid. Of 1391 unique articles, 36 were eligible for inclusion. Diverse biochemical and epigenomic effects of supplementation were identified that may influence innate and adaptive immunity. Possible clinical benefits were encountered in malaria, HIV infections, anemia, Type 1 diabetes mellitus, and preventing preterm delivery. Only limited publications were identified that directly explored maternal immunity in pregnancy and the effects of micronutrients. None provided a holistic perspective. It is concluded that supplementation may influence biochemical aspects of the maternal immune response and some clinical outcomes, but the evidence from this review is not sufficient to justify changes to current guidelines.

Objective: Postpartum women experience thyroid dysfunction at twice the prevalence of the general population. Adequate biosynthesis of thyroid hormones depends on three trace elements: iodine, selenium and iron. This study aimed to investigate thyroid dysfunction within a cohort of women at six months postpartum in relation to iodine, selenium and iron status., Design: This cross-sectional study was part of an observational longitudinal cohort Mother and Infant Nutrition Investigation; data obtained at six months postpartum are reported., Subjects: Mother-infant pairs (n = 87) were recruited at three months postpartum and followed up at six months postpartum (n = 78)., Measurements: Thyroid hormones (free triiodothyronine, free thyroxine, thyroid-stimulating hormone) and thyroid peroxidase antibodies were measured. Urinary iodine concentration, breast milk iodine concentration, serum thyroglobulin, plasma selenium, serum ferritin and serum soluble transferrin receptors were determined. Nonparametric data were expressed as median (25th, 75th percentile)., Results: Thyroid dysfunction was found in 18% of women, and 4% of women had iron deficiency. Median urinary iodine concentration was 85 (43, 134) µg/L, median breast milk iodine concentration was 59 (39, 109) µg/L, and median serum thyroglobulin at 11.4 (8.6, 18.6) µg/L, indicating iodine deficiency. Median plasma selenium concentration was 105.8 (95.6, 115.3) µg/L. Women with marginally lower plasma selenium concentration were 1.12% times more likely to have abnormal TSH concentrations (p = .001)., Conclusions: There was a high prevalence of thyroid dysfunction. Plasma selenium concentration was the only significant predictor of the likelihood that women had thyroid dysfunction within this cohort, who were iodine deficient and mostly had adequate iron status. Strategies are required to improve both iodine and selenium status to better support maternal thyroid function., (© 2021 John Wiley & Sons Ltd.)

We aimed to identify the factors influencing child height-for-age z-scores (HAZ) as a measure of child nutritional status in Rwanda, and to examine the role of child feeding and health practices. We conducted a cross-sectional study involving 379 children (aged 6-23 months) and their mothers in northwest Rwanda. Data were collected using a pre-tested, structured questionnaire. An infant and young child feeding practices index (ICFI) and health practices index (HPI) were developed and categorised into tertiles, and linear regression analyses were performed to assess their association with child HAZ. Overall, mothers of non-stunted children exhibited better feeding and health practices than those of stunted children. ICFI was positively associated with child HAZ. We found an adjusted mean HAZ difference of 0·14 between children whose mothers were in high ICFI tertile compared with those in low tertile. Neither HPI nor any of its components were significantly associated with child HAZ. Other factors that were positively associated with child HAZ were infant birth weight (P < 0·001) and maternal height (P < 0·001). Child age, sex (male) (P < 0·05) and altitude (P < 0·05) were negatively associated with child HAZ. Diarrhoea (P < 0·05) and respiratory infections (P < 0·05) were negatively associated with HAZ in younger children aged 6-11 months. Policies to reduce stunting in this population must focus on both pre- and postnatal factors. Appropriate child feeding practices, particularly breast-feeding promotion and improvement in children's dietary diversity combined with measures to control infections should be given priority.

Adequate iodine status during conception, pregnancy and lactation is essential for supporting infant neurodevelopment. Iodine status in adults and children was improved after two New Zealand government initiatives, but the status of breastfeeding women is unknown. This study aimed to investigate the iodine intake and status of lactating mother-infant pairs at 3 months postpartum and to assess maternal iodine knowledge and practice. Iodine intake was estimated by a weighed 4-day diet diary (4DDD). Maternal urinary iodine concentrations (UIC) in spot urine, breast milk iodine concentrations (BMIC) and infant UIC were measured. Questions about iodine-specific knowledge and practice were asked. In 87 breastfeeding mother-infant pairs, maternal iodine intake was 151 (99, 285) μg/day, and 58% had an intake below the estimated average requirement (EAR) of 190 μg/day. Maternal median UIC (MUIC) was 82 (46, 157) μg/L indicating iodine deficiency (i.e., < 100 μg/L). Women who used iodine-containing supplements had a significantly higher MUIC (111 vs 68 μg/L, P = 0.023) and BMIC (84 vs 62 μg/L, P < 0.001) than non-users. Infants fed by women using iodine-containing supplements had a higher MUIC (150 vs 86 μg/L, P = 0.036) than those of non-users. A total of 66% (57/87) of women had no or low iodine knowledge. The iodine knowledge score was a statistically significant predictor of consuming iodine-containing supplements [(beta = 1.321, P = 0.008)]. Despite a decade of initiatives to increase iodine intakes in New Zealand, iodine knowledge was low; iodine intake and status of these lactating women were suboptimal, but women who used iodine-containing supplement were more likely to achieve adequate status.Study Registration Number (Australia and New Zealand Clinical Trials Registry): ACTRN12615001028594.

Objective: To explore and gain an in-depth understanding of the factors influencing child feeding practices among rural caregivers in Rwanda., Design: In-depth semi-structured qualitative interviews were conducted. Purposive sampling was used to recruit participants. Interviews were audio-recorded, transcribed verbatim and coded. Data were analysed inductively using thematic analysis., Setting: Rutsiro District, Western Province, Rwanda., Participants: Participants included twenty-four mothers (median age 32 years) with children 6-23 months old., Results: We identified five key themes: (i) breast-feeding practices and role in food supply; (ii) family v. children's food preparations; (iii) food classification systems and their influence on child feeding decisions; (iv) child feeding during diarrhoeal episodes and (v) influence of poverty on child feeding practices and child care., Conclusions: Mothers' infant and young child feeding decisions are informed by information both from health workers and from traditional/own knowledge. Navigating through this information sometimes creates conflicts which results in less than optimal child feeding. A nutrition educational approach that is cognisant of maternal perceptions should be employed to improve child feeding practices. Efforts to improve child feeding practices must be complemented by programmes that enhance household economic opportunities and access to foods.

The World Health Organization recommends point-of-use fortification with multiple micronutrients powder (MNP) for foods consumed by children aged 6-23 months in populations where anemia prevalence among children under 2 years or under 5 years of age is 20% or higher. In Rwanda, anemia affects 37% of children under 5 years. The MNP program was implemented to address anemia, but research on factors affecting the implementation of the MNP program is limited. We conducted a mixed-methods study to examine the factors influencing access to and use of MNP among mothers (N=379) in Rutsiro district, northwest Rwanda. Inductive content analysis was used for qualitative data. Logistic regression analysis was used to determine factors associated with the use of MNP. Qualitative results indicated that the unavailability of MNP supplies and distribution issues were major barriers to accessing MNP. Factors influencing the use of MNP included mothers' perceptions of side effects and health benefits of MNP, as well as inappropriate complementary feeding practices. Mothers of older children (aged 12-23 months) were more likely to use MNP than those of younger children (aged 6-11 months) (adjusted odds ratio [aOR]=3.63, P <.001). Mothers whose children participated in the supplementary food program were nearly 3 times more likely to use MNP than those whose children had never participated in the program (aOR=2.84, P =.001). Increasing household hunger score was significantly associated with lower odds of using MNP (aOR=0.80, P =.038). Mechanisms to monitor MNP supply and program implementation need to be strengthened to ensure mothers have access to the product. MNP program implementers should address gaps in complementary feeding practices and ensure mothers have access to adequate complementary foods., (© Dusingizimana et al.)

Perceived insufficient milk production (PIM) adversely affects breastfeeding duration. Women sometimes use galactagogues with the intent to increase breast milk production and support lactation. Saccharomyces cerevisiae yeast-based supplement (SCYS) is an inactive form of Saccharomyces cerevisiae yeast (SCY) either obtained from the fermentation process or grown on molasses. Anecdotal evidence suggests SCYS is a galactagogue. SCYS is promoted on the internet as a galactagogue in various forms and doses. Dietary supplementation with SCYS during gestation and lactation significantly increases milk yield in ruminants. No human study has evaluated efficacy of SCYS as a galactagogue. SCYS is rich in B vitamins, beta-glucan, mannan oligosaccharides and bioavailable chromium; these may impact breast milk production or composition, thus may alleviate PIM. The safety of taking SCYS during lactation is not well studied. Studies have reported contamination of SCYS with ochratoxin A (OTA) as well as minor side effects from SCYS. Studies are needed to evaluate the efficacy of SCYS on breast milk production and composition and to assess the safety of taking SCYS during lactation in humans.

Background: Thyroid dysfunction is associated with cognitive impairment, mood disturbance, and postnatal depression. Sufficient thyroid hormone synthesis requires adequate intake of iodine, selenium, and iron. Iodine deficiency was historically a problem for New Zealand, and initiatives were introduced to overcome the problem: (1) mandatory fortification of all bread (except organic) with iodized salt (2009) and (2) provision of subsidized iodine supplements for pregnant and breastfeeding women (2010). Subsequent to these initiatives, most adults and children have adequate iodine status; however, status among breastfeeding women and their infants remains unclear. This paper outlines the methodology of the Mother and Infant Nutrition Investigation (MINI) study: an observational longitudinal cohort study of breastfeeding women and their infants., Objective: This study will determine (1) women's iodine intake and status among supplement users and nonusers; (2) women's intake and status of iodine, selenium, and iron relating to thyroid function; (3) associations between women's selenium status, thyroid function, and postnatal depression; (4) infants' iodine and selenium status relating to first year neurodevelopment., Methods: Breastfeeding women aged over 16 years with a healthy term singleton infant were recruited from Manawatu, New Zealand. Participants attended study visits 3, 6, and 12 months postpartum. Maternal questionnaires investigated supplement use before and after birth, iodine knowledge, and demographic information. Dietary assessment and urine, blood, and breast milk samples were taken to measure iodine, selenium, and iron intake/status. The Edinburgh Postnatal Depression Scale was used repeatedly to screen for postnatal depression. Thyroid hormones (free triiodothyronine, free thyroxine, thyroid stimulating hormone, thyroglobulin, antithyroglobulin antibodies, and antithyroid peroxidase) were measured in blood samples, and thyroid gland volume was measured by ultrasound at 6 months postpartum. Infant iodine and selenium concentrations were determined in urine. The Ages and Stages Questionnaire was used to assess infant development at 4, 8, and 12 months., Results: Data collection was completed. Biological samples analysis, excluding nail clippings, is complete. Data analysis and presentation of the results will be available after 2020., Conclusions: This study will provide data on the current iodine status of breastfeeding women. It will also provide a greater understanding of the three essential minerals required for optimal thyroid function among breastfeeding women. The prospective longitudinal design allows opportunities to examine women's mental health and infant neurodevelopment throughout the first year, a crucial time for both mothers and their infants., Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12615001028594; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369324., International Registered Report Identifier (irrid): DERR1-10.2196/18560., (©Ying Jin, Jane Coad, Shao J Zhou, Sheila Skeaff, Cheryl Benn, Nicholas Kim, Rachael L Pond, Louise Brough. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 27.08.2020.)

Background: Selenium (Se) plays an important role in selenoproteins as an antioxidant, and is involved in thyroid function, mental health and child development. Selenium is low in the local food supplies in NZ. Low selenium intake has been reported in women of childbearing age and postmenopausal women, however, there is little research relating to breastfeeding women and their infants., Purpose: The study investigates maternal and infant selenium intake and status during the first year postpartum, and possible relationships to postnatal depression and anxiety., Basic Procedures: The Mother and Infant Nutrition Investigation (MINI) study is an observational longitudinal cohort study. In total 87 breastfeeding mother-infant pairs were recruited and followed up at 3, 6 and 12 months postpartum. Maternal selenium intake was estimated from a four-day diet diary (4DDD). Selenium concentrations were measured in maternal spot urine, breastmilk and plasma; and infant spot urine samples. Postnatal depression was screened by the Edinburgh Postnatal Depression Scale (EPDS) questionnaire., Main Findings: Median maternal selenium intake was 62 (50, 84) μg/day, with 56 % below the Estimated Average Requirement (EAR) of 65 μg/day. At 3, 6, and 12 months postpartum, median maternal urinary selenium:creatinine ratios were 29.0 (22.4, 42.0), 29.5 (23.1, 28.4), and 30.9 (24.3, 35.3) μg/g; median infant urinary selenium concentrations (IUSC) were 8 (6,13), 11 (6, 15), and 24 (10, 40) μg/L; median breastmilk selenium concentrations (BMSC) were 13 (11, 14), 11 (9, 11) and 12 (11, 13) μg/L; 18 %, 11 % and 14 % of women reported probable minor depression based on the EPDS scores equal or above 10. Estimated median infant selenium intake at 3 and 6 months were 9 (8, 11) and 8 (7, 10) μg/day with 85 % and 93 % below the Adequate Intake of 12 μg/day. Median maternal plasma selenium was 105.8 μg/L at 6 months postpartum. Minor depression at three months postpartum was significantly different across tertiles of plasma selenium concentrations (p = 0.041)., Principle Conclusions: Suboptimal selenium intake was observed among breastfeeding mothers and their infants in the MINI study. Potentially, some women had insufficient selenium status. Relation between selenium status and risk of postnatal depression and anxiety was inconclusive.Further research is required to explore effects on maternal thyroid function and infant neurodevelopment among women with inadequate selenium intake and status., (Copyright © 2020 Elsevier GmbH. All rights reserved.)

We would like to thank Moran and Sanchez Fernandez [...].

Young adulthood is an important stage in the accrual of bone mass. Young women are often unaware of the need, and how to optimize modifiable risk factors, particularly intake of nutrients associated with good bone health. In this study, an accessible way to estimate osteoporosis risk, quantitative ultrasound (QUS), is compared to the gold-standard technique dual X-ray absorptiometry (DXA) in a group of 54 healthy young women (18-26 years) from Manawatu, New Zealand, and the relationship with nutrient intake is investigated. Broadband ultrasound attenuation and speed of sound (BUA, SOS) were assessed by QUS calcaneal scans and bone mineral concentration/density (BMC/BMD) were determined by DXA scans of the lumbar spine and hip (total and femoral neck). Dietary intake of energy, protein, and calcium was estimated using three-day food diaries and questionnaires. DXA mean Z -scores (>-2.0) for the hip (0.19) and spine (0.2) and QUS mean Z -scores (>-1.0) (0.41) were within the expected ranges. DXA (BMD) and QUS (BUA, SOS) measurements were strongly correlated. Median intakes of protein and calcium were 83.7 g/day and 784 mg/day, respectively. Protein intake was adequate and, whilst median calcium intake was higher than national average, it was below the Estimated Average Requirement (EAR). No significant relationship was found between dietary intake of calcium or protein and BMD or BMC. To conclude, QUS may provide a reasonable indicator of osteoporosis risk in young women but may not be an appropriate diagnostic tool. Increased calcium intake is recommended for this group, regardless of BMD.

In women, the menopausal transition is characterized by acid-base imbalance, estrogen deficiency and rapid bone loss. Research into nutritional factors that influence bone health is therefore necessary. In this study, the relationship between nutrient patterns and nutrients important for bone health with bone mineral density (BMD) was explored. In this cross-sectional analysis, 101 participants aged between 54 and 81 years were eligible. Body composition and BMD analyses were performed using dual-energy X-ray absorptiometry (DXA). Nutrient data were extracted from a 3-day diet diary (3-DDD) using Foodworks 9 and metabolic equivalent (MET-minutes) was calculated from a self-reported New Zealand physical activity questionnaire (NZPAQ). Significant positive correlations were found between intakes of calcium ( p = 0.003, r = 0.294), protein ( p = 0.013, r = 0.246), riboflavin ( p = 0.020, r = 0.232), niacin equivalent ( p = 0.010, r = 0.256) and spine BMD. A nutrient pattern high in riboflavin, phosphorus and calcium was significantly positively correlated with spine ( p < 0.05, r = 0.197) and femoral neck BMD ( p < 0.05, r = 0.213), while the nutrient pattern high in vitamin E, α-tocopherol, β-carotene and omega 6 fatty acids was negatively correlated with hip ( p < 0.05, r = -0.215) and trochanter BMD ( p < 0.05, r = -0.251). These findings support the hypothesis that a nutrient pattern high in the intake of vitamin E, α-tocopherol and omega 6 fatty acids appears to be detrimental for bone health in postmenopausal women., Competing Interests: The authors declare no conflict of interest. The funders 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.

Selenium plays a role in antioxidant status and, together with iodine, in thyroid function. Iodine deficiency exists in New Zealand during pregnancy and lactation, and selenium deficiency may further affect thyroid function. This study investigated selenium intakes of pregnant and lactating women, in Palmerston North, in the North Island of New Zealand. Dietary intake was estimated using three repeated 24-h dietary recalls. Dietary intake in pregnancy was also estimated from 24-h urinary excretion of selenium. Selenium concentrations were determined in urine and breastmilk using inductively-coupled plasma mass spectrometry. Median selenium intakes based on dietary data were 51 (39, 65) μg/day in pregnancy and 51 (36, 80) μg/day in lactation, with 61% and 68% below estimated average requirement (EAR). Median daily selenium intake in pregnancy based on urinary excretion was 49 (40, 60) µg/day, with 59% below EAR. Median selenium concentration in breastmilk was 11 (10, 13) µg/L and estimated median selenium intake for infants was 9 (8, 10) µg/day, with 91% below the Adequate Intake of 12 μg/day. These pregnant and breastfeeding women were at risk of dietary selenium inadequacy. Further research is required to assess selenium status in relation to thyroid function and health in this group.

Dysbiotic gut microbiota have been implicated in human disease. Diet-based therapeutic strategies have been used to manipulate the gut microbiota towards a more favourable profile. However, it has been demonstrated that large inter-individual variability exists in gut microbiota response to a dietary intervention. The primary objective of this study was to investigate whether habitually low dietary fibre (LDF) v. high dietary fibre (HDF) intakes influence gut microbiota response to an inulin-type fructan prebiotic. In this randomised, double-blind, placebo-controlled, cross-over study, thirty-four healthy participants were classified as LDF or HDF consumers. Gut microbiota composition (16S rRNA bacterial gene sequencing) and SCFA concentrations were assessed following 3 weeks of daily prebiotic supplementation (Orafti® Synergy 1; 16 g/d) or placebo (Glucidex® 29 Premium; 16 g/d), as well as after 3 weeks of the alternative intervention, following a 3-week washout period. In the LDF group, the prebiotic intervention led to an increase in Bifidobacterium (P=0·001). In the HDF group, the prebiotic intervention led to an increase in Bifidobacterium (P<0·001) and Faecalibacterium (P=0·010) and decreases in Coprococcus (P=0·010), Dorea (P=0·043) and Ruminococcus (Lachnospiraceae family) (P=0·032). This study demonstrates that those with HDF intakes have a greater gut microbiota response and are therefore more likely to benefit from an inulin-type fructan prebiotic than those with LDF intakes. Future studies aiming to modulate the gut microbiota and improve host health, using an inulin-type fructan prebiotic, should take habitual dietary fibre intake into account.

Dysbiosis is linked to human disease; therefore, gut microbiota modulation strategies provide an attractive means of correcting microbial imbalance to enhance human health. Because diet has a major influence on the composition, diversity, and metabolic capacity of the gut microbiota, numerous dietary intervention studies have been conducted to manipulate the gut microbiota to improve host outcomes and reduce disease risk. Emerging evidence suggests that interindividual variability in gut microbiota and host responsiveness exists, making it difficult to predict gut microbiota and host response to a given dietary intervention. This may, in turn, have implications on the consistency of results among studies and the perceived success or true efficacy of a dietary intervention in eliciting beneficial changes to the gut microbiota and human health., (© The Author(s) 2017. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Iodine and selenium are required for thyroid function. This study investigated iodine and selenium intakes in healthy, women aged 50-70 years ( n = 97) from three cities in the North Island of New Zealand, after mandatory fortification of bread with iodised salt. Iodine and selenium concentrations were determined in 24-h urine samples; daily intakes were extrapolated from amounts in urine (90% and 55% of daily intake, respectively). Three day diet diaries (3DDD) also estimated selenium and iodine (excluding iodised salt) intake. Median urinary iodine concentration (UIC) was 57 (41, 78) µg/L, indicating mild iodine deficiency. Estimated median iodine intake based on urine was 138 (100, 172) µg/day, below Recommended Dietary Intake (RDI) (150 µg/day) with 25% below Estimated Average Requirement (EAR) (100 µg/day). Estimated median selenium intake was 50 (36, 71) µg/day based on urine and 45 (36, 68) µg/day using 3DDD, below RDI (60 µg/day) with 49%-55% below EAR (50 µg/day). Median bread intakes were low at 1.8 (1.1, 2.7) serves/day; 25% consumed ≤1 serve/day. Although population iodine intakes improved following mandatory fortification, some had low intakes. Selenium intakes remain low. Further research should investigate thyroid function of low consumers of iodine fortified bread and/or selenium in New Zealand.

Low dietary fibre intake has been associated with poorer health outcomes, therefore having the ability to be able to quickly assess an individual's dietary fibre intake would prove useful in clinical practice and for research purposes. Current dietary assessment methods such as food records and food frequency questionnaires are time-consuming and burdensome, and there are presently no published short dietary fibre intake questionnaires that can quantify an individual's total habitual dietary fibre intake and classify individuals as low, moderate or high habitual dietary fibre consumers. Therefore, we aimed to develop and validate a habitual dietary fibre intake short food frequency questionnaire (DFI-FFQ) which can quickly and accurately classify individuals based on their habitual dietary fibre intake. In this study the DFI-FFQ was validated against the Monash University comprehensive nutrition assessment questionnaire (CNAQ). Fifty-two healthy, normal weight male (n = 17) and female (n = 35) participants, aged between 21 and 61 years, completed the DFI-FFQ twice and the CNAQ once. All eligible participants completed the study, however the data from 46% of the participants were excluded from analysis secondary to misreporting. The DFI-FFQ cannot accurately quantify total habitual dietary fibre intakes, however, it is a quick, valid and reproducible tool in classifying individuals based on their habitual dietary fibre intakes., Competing Interests: The authors declare no conflict of interest.

Introduction: The commensal gut microbiota have been shown to have an impact on human health as aberrant gut microbiota have been linked to disease. Dietary constituents are influential in shaping the gut microbiota. Diet-specific therapeutic strategies may therefore play a role in optimising human health via beneficial manipulation of the gut microbiota. Research has suggested that an individual's baseline gut microbiota composition may influence how the gut microbiota respond to a dietary intervention and individuals with differing habitual dietary intakes appear to have distinct baseline gut microbiota compositions. The responsiveness of the gut microbiota may therefore be influenced by habitual dietary intakes. This study aims to investigate what influence differing habitual dietary fibre intakes have on the responsiveness of the gut microbiota to a prebiotic intervention., Methods and Analysis: In this randomised, double-blind, placebo-controlled, cross-over, single-centre study, 20 low dietary fibre (dietary fibre intake <18 g/day for females and <22 g/day for males) and 20 high dietary fibre (dietary fibre intake ≥25 g/day for females and ≥30 g/day for males) consumers will be recruited. Participants will be randomised to a placebo (Glucidex 29 Premium) or a prebiotic (Synergy 1) intervention for 3 weeks with a 3-week washout followed by 3 weeks of the alternative intervention. Outcome measures of gut microbiota composition (using 16S rRNA gene sequencing) and functional capacity (faecal short chain fatty acid concentrations and Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt)) as well as appetite (visual analogue scale appetite questionnaire) will be assessed at the beginning and end of each intervention phase., Ethics and Dissemination: The Massey University Human Ethics Committee approved this study (Massey University HEC: Southern A application-15/34). Results will be disseminated through peer-review journal publications, conference presentations and a summary of findings will be distributed to participants., Trial Registration Number: ACTRN12615000922572; Pre-results., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Iodine deficiency during pregnancy and lactation may adversely affect fetal and infant development. Two initiatives were introduced in New Zealand to prevent deficiency: (1) mandatory fortification of bread with iodised salt; and (2) provision of a subsidised iodine supplement (150 μg) for all pregnant and breastfeeding women. The aim of this study was to assess iodine intake and status among a self-selecting sample of pregnant and lactating women in Palmerston North, both before and after the two initiatives. Pregnant and breastfeeding women were recruited before (n = 25 and 32; 2009) and after (n = 34 and 36; 2011) the initiatives. Iodine concentration was determined in 24-h urine and breast milk samples using inductively-coupled plasma mass spectrometry. Use of supplements and salt, knowledge of iodine deficiency, and awareness of the initiatives were determined by questionnaire. Median urine iodine concentration (UIC) was higher in 2011 compared with 2009 for both pregnant (85 and 47 μg L(-1) ) and breastfeeding (74 and 34 μg L(-1) ) participants; median UIC were below the cut-offs for adequate iodine status. However, in 2011, the estimated daily iodine intake during pregnancy was 217 μg day(-1) ; 74% of women achieved the Estimated Average Requirement. Knowledge of the initiatives was low, only 28-56% were aware of the need for iodine supplements and only 15-22% were aware of the mandatory addition of iodised salt to bread. Despite initiatives, UIC of these women indicates iodine deficiency, however, dietary intakes appear adequate. Ongoing surveillance of supplement use and iodine status among pregnant and lactating women throughout New Zealand is needed to fully assess the efficacy of the initiatives. Alternative strategies may require evaluation to ensure all women have adequate iodine during pregnancy and breastfeeding., (© 2013 John Wiley & Sons Ltd.)

Background: Cereal-based complementary foods from non-malted ingredients form a relatively high viscous porridge. Therefore, excessive dilution, usually with water, is required to reduce the viscosity to be appropriate for infant feeding. The dilution invariably leads to energy and nutrient thinning, that is, the reduction of energy and nutrient densities. Carbohydrate is the major constituent of food that significantly influences viscosity when heated in water., Objectives: To compare the sweetpotato-based complementary foods (extrusion-cooked ComFa, roller-dried ComFa, and oven-toasted ComFa) and enriched Weanimix (maize-based formulation) regarding their 1) carbohydrate composition, 2) viscosity and water solubility index (WSI), and 3) sensory acceptance evaluated by sub-Sahara African women as model caregivers., Methods: The level of simple sugars/carbohydrates was analysed by spectrophotometry, total dietary fibre by enzymatic-gravimetric method, and total carbohydrate and starch levels estimated by calculation. A Rapid Visco™ Analyser was used to measure viscosity. WSI was determined gravimetrically. A consumer sensory evaluation was used to evaluate the product acceptance of the roller-dried ComFa, oven-toasted ComFa, and enriched Weanimix., Results: The sweetpotato-based complementary foods were, on average, significantly higher in maltose, sucrose, free glucose and fructose, and total dietary fibre, but they were markedly lower in starch content compared with the levels in the enriched Weanimix. Consequently, the sweetpotato-based complementary foods had relatively low apparent viscosity, and high WSI, than that of enriched Weanimix. The scores of sensory liking given by the caregivers were highest for the roller-dried ComFa, followed by the oven-toasted ComFa, and, finally, the enriched Weanimix., Conclusion: The sweetpotato-based formulations have significant advantages as complementary food due to the high level of endogenous sugars and low starch content that reduce the viscosity, increase the solubility, impart desirable sensory characteristics, and potentially avoid excessive energy and nutrient thinning.

The availability of micronutrients from sweetpotato-based complementary foods (CFs): oven-toasted and roller-dried ComFa, and from a maize-based infant food, enriched Weanimix, was compared using phytate/mineral molar ratios, polyphenols and β-carotene levels. The phytate/calcium, iron and zinc molar ratios of approximately 0.17, 1 and 15 predict better absorption of calcium, iron and zinc respectively. Generally, the sweetpotato-based CFs had at least half the phytate/mineral ratios of enriched Weanimix. The phytate/iron ratio in both the sweetpotato- and the maize-based CFs was greater than 1. Only the ComFa formulations had phytate/zinc ratio lower than 15. The level of polyphenol (iron inhibitor) was similar for the formulations. Only the sweetpotato-based CFs contained measurable levels of β-carotene, a possible iron enhancer. The lower phytate/mineral ratios and the β-carotene level of the sweetpotato-based CFs suggest that calcium, iron and zinc absorption could be better from them than from the maize-based infant food.