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BACKGROUND/OBJECTIVES: Sifted flour was fortified with carbonyl iron for 50 years in Sweden. This study evaluates changes in food habits, intake of iron, factors affecting iron absorption and iron status after the discontinuation of the general iron fortification in adolescents with the highest requirements. SUBJECTS/METHODS: A total of 2285 15- to 16-year-old students in 1994 (634 girls and 611 boys) and in 2000 (534 girls and 486 boys) in 13 schools in Gothenburg, Sweden, were included in two cross-sectional surveys assessing food habits with diet history interviews and iron deficiency defined with serum ferritin stores [less than or equal to] 15 [micro]g/l and no preceding infection. RESULTS: In girls, iron deficiency increased from 37 to 45%, while in boys, it was stable at 23%. Total iron intake decreased from 15.7 to 9.5 mg/day and 22.5 to 13.9 mg/day in girls and boys, respectively. Cereals were the main iron source. Among girls, the increase of fish and decrease of calcium intake may not counteract the effect of decreased intake of fortification iron. Among boys, more meat, less calcium and more vitamin C may have favoured the bioavailability of iron. CONCLUSIONS: The discontinuation of the general iron fortification resulted in a 39% decrease in total iron intake and iron deficiency increased substantially in girls. However, in boys no change in iron deficiency was observed. Whether this was a result of changed bioavailability of dietary iron or simultaneous changes of non-dietary factors remains to be explored. European Journal of Clinical Nutrition (2015) 69, 494-500; doi:10.1038/ejcn.2014.291; published online 28 January 2015, INTRODUCTION In Sweden white wheat flour was fortified with iron from 1944 to 1994. The fortification, carbonyl iron, was added to sifted flour at the mills. The iron-fortified flour was [...]

BACKGROUND/OBJECTIVES: Anorexia or lack of appetite is common in chronic obstructive pulmonary disease (COPD) and may be caused or augmented by several symptoms affecting appetite and eating. We aimed to investigate and quantify the extent of nutrition impact symptoms (NIS) in patients with COPD and to explore relationships between NIS and fat-free mass depletion. SUBJECTS/METHODS: The results in this cross-sectional study are based on 169 COPD patients (62% female subjects). Body composition was assessed using bioelectrical impedance spectroscopy and the patients reported NIS by two newly developed questionnaires: the Eating Symptoms Questionnaire (ESQ) and the Disease-Related Appetite Questionnaire (DRAQ). RESULTS: Symptoms with the highest prevalence were dry mouth (71%), stomach ache (39%), pain or aches affecting appetite (36%) and constipation (35%). Problems with diarrhoea and feeling affected by smells were more severe among women compared with men (P < 0.05). Thirty-six percent of the patients were depleted (fat-free mass index (FFMI) < 15 kg/[m.sup.2] for women and FFMI < 16 kg/[m.sup.2] for men). Depleted patients had more NIS (P < 0.05) and also rated appetite and taste of food as worse compared with non-depleted patients (P < 0.05). CONCLUSIONS: NIS are common in patients with COPD, and depleted patients have more severe symptoms. To investigate how these symptoms are best prevented and/or managed and whether NIS prevention/treatment can affect development of malnutrition in patients with COPD is a challenge for the future. European Journal of Clinical Nutrition (2015) 69, 256-261;Doi:10.1038/ejcn.2014.76; published Online 7 May 2014, INTRODUCTION Chronic obstructive pulmonary disease (COPD) is characterised by a persistent airflow limitation that is associated with an enhanced chronic inflammatory response to noxious particles and gases in the airways [...]

Background/Objectives: Almost 50% of all chronic obstructive pulmonary disease (COPD) patients become underweight. One possible reason for nutritional treatment to fail could be miscalculation of patients' energy requirements. The aim of this study was, therefore, to evaluate simple measures that may be used to assess the energy requirement of COPD patients. Subjects/Methods: This cross-sectional evaluation study includes 68 COPD patients (42 women). Resting metabolic rate (RMR) was assessed by indirect calorimetry, while total energy expenditure (TEE) was assessed by a 7-day monitoring using the ActiReg. Simple measures to evaluate was body weight (kg) multiplied by 125 kJ (30 kcal), predicted rMr multiplied by 1.7 and two simple questionnaires. Results: Mean physical activity level (PAL) from the ActiReg was 1.46. Calculation of energy expenditure multiplying body weight with 125 kJ resulted in a TEE of 8614 kJ compared with ActiReg 8317 kJ (P = 0.10). To multiply predicted RMR by 1.7 resulted in a statistically significant overestimation of 1335 kJ (P Conclusions: This study shows that simple measures of energy expenditure could, on group level, assess COPD patient's energy needs. However, for individual assessment of energy need, more thorough procedures are necessary. European journal of Clinical Nutrition (2011) 65, 1309-1313; doi: 10.1038/ejcn.2011.117; published online 22 June 2011 Keywords: physical activity; malnutrition; energy requirements; ActiReg, Introduction Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death in Sweden as well as in many other countries (Hoyert et al, 2006; WHO, 2008; Socialstyrelsen, [...]

Background/Objectives: Sweden has had a salt iodination program since 1936. This first national surveillance study on iodine nutrition infers an adequate level of urinary iodine concentration (UIC 125 µg/l) and the aim is now to evaluate thyroid volume (Tvol) in the same national sample. Subjects/Methods: A stratified probability proportionate to size cluster sampling was used to obtain a representative national sample of Swedish children aged 6-12 years. Median Tvol obtained ultrasonographically and the prevalence of enlarged thyroid glands were compared with an international reference standard. Regional differences were evaluated through comparisons of Tvol between coastal and inland areas, urban and rural regions, and former goitre and non-goitre regions. Results: Tvol was correlated with age, body surface area (BSA), weight, height and body mass index for both sexes (P< 0.0001) but not with UIC. The most important predictors for Tvol were age (girls: P< 0.0001, boys: P = 0.001) and BSA (girls: P< 0.0001, boys: P< 0.01). Median Tvol was higher in Sweden than in the reference study (P< 0.0001). The prevalence of goitre was higher in Sweden (correlated to age 22.3%, BSA 15.7%, weight 17.6%, height 12.9%) than in the international reference (correlated to age 2.5%, BSA 2.5%, weight 2.5%, height 2.5%) (P Conclusions: Tvols were higher in Swedish school children than in the international reference study although iodine intake is considered optimal in Sweden. These findings underline the importance of regular monitoring of iodine intake, especially with regard to the decreased intake of table salt that is likely to follow initiation of health campaigns. European Journal of Clinical Nutrition (2010) 64, 1289-1295; doi: 10.1038/ejcn.2010.162; published online 25 August 2010 Keywords: thyroid volume; iodine; goitre; national; Sweden; children, Introduction In Sweden, goitre was first described by Carl von Linne in 1747, and in the beginning of the twentieth century goitre was detected in 60% of cases in certain [...]

Background/Objectives: Sweden has a long-standing salt iodization program; however, its effects on iodine intake have never been monitored on a national level. The objective of this study was to evaluate iodine nutrition in the Swedish population by measuring the urinary iodine concentration (UIC) in a national sample of Swedish school-age (6-12 years of age) children. Subjects/Methods: A stratified probability proportionate to size cluster sampling method was used to obtain a representative national sample of school-age children from 30 clusters. Spot urine samples were collected for UIC analysis using a modified Sandell-Kolthoff method. Results: The median UIC of the children (n=857) was 125[micro]g/l (range 11-757 [micro]g/l). The proportion of children with a UIC 300 [micro]g/l was 5.5 and 3.0%, respectively. Conclusions: The iodine nutritional status of the Swedish population is adequate. Iodized table salt remains the main dietary source of iodine in Swedish diet. Recommendations to reduce total salt intake in the population urge increased use of iodized salt in the production of processed foods. Pregnant and lactating women with high iodine requirements may still be at risk for low iodine intake. This study will serve as the basis for future monitoring of iodine nutritional status in Sweden. doi:10.1038/ejcn.2008.46; published online 10 September 2008 Keywords: iodine; urinary iodine concentration; monitoring; Sweden; children; salt, Introduction Iodine deficiency remains a public health problem in 47 countries worldwide (de Benoist et al., 2008). Adequate dietary iodine intake is essential for the production of thyroid hormones. Low [...]

Background: The most common method of combating iron deficiency is iron fortification, especially in developing countries. However, few studies have shown a significant effect on iron status following iron fortification of low bioavailability diets. Objective: To investigate how iron fortification and dietary modifications affect iron absorption and rates of changes in iron stores. Methods: Research has made it possible to predict both iron absorption and the effects of iron fortification and diet modifications on iron stores using recently developed algorithms. Iron absorption and rate of change in iron stores were calculated from nine diets representing a broad range of iron bioavailability and iron contents. The calculations were related to the main target group for iron fortification, that is, women of reproductive age having empty stores but normal haemoglobin concentrations. Results: As the only measure, iron fortification has practically no effect on iron status if the original diet has low bioavailability. However, after dietary modifications such a diet shows a positive effect on iron stores. The combined action of fortification (6 mg/day) and modest bioavailability changes in a low bioavailability diet results approximately in 40 and 70% greater increases in iron stores than through iron fortification or dietary modification alone. Conclusions: It is difficult to achieve good effects on iron status from iron fortification as the only measure if the diet has low bioavailability. Both dietary modifications as well as iron fortification are required to improve effectively the iron status of a population. doi:10.1038/sj.ejcn.1602776; published online 30 May 2007 Keywords: iron absorption; iron bioavailability; iron fortification; dietary modification; women; developing countries, Introduction The primary cause of iron deficiency, apart from iron loss caused by blood loss through parasite infestation (for example, hookworm), is the inability to cover iron requirements with the [...]

Background: Iron stores and haemoglobin iron deficits in menstruating women can be calculated from body iron losses and absorption of dietary iron using recently developed methods. Objective: To examine iron balance (iron status) expressed as body iron stores or haemoglobin iron deficites in menstruating women from amounts of iron lost (iron requirements) and amounts of dietary iron absorbed. Calculations are made both of stationary states and of the rate of changes in iron stores (iron status) when any of the two main factors determining iron balance are changed. Design: The study is based on (1) previous and new equations describing relationships between iron absorption, iron requirements (losses), iron stores and/or haemoglobin deficits and (2) published data on iron requirements and their variation in menstruating adult women. Results: Both iron stores and haemoglobin iron deficits are strongly related to iron requirements and absorption of dietary iron and follow the same equations during states of iron repletion and iron deficiency. When, for example, increasing or decreasing the bioavailability of the dietary iron, about 90% of the change in iron stores will occur within 1 y. Conclusions: There are strong relationships between iron requirements, bioavailability of dietary iron and amounts of stored iron. The observations that a reduction in iron stores and a calculated decrease of haemoglobin iron had the same increasing effect on iron absorption suggest that the control of iron absorption is mediated from a common cell, that may register both size of iron stores and hemoglobin iron deficit, eg the hepatocyte. Sponsorship: The Swedish Medical Research Council (project B96-19X-04721-21A), the Swedish Council for Forestry and Agriculture Research (50.0120/95 and 997/881, 113:3), the Swedish Dairy Association and The Danone International Prize for Nutrition 1999 (LH). Descriptors: iron absorption; diet; bioavailability; iron requirements; iron stores; iron deficiency; haemoglobin iron deficit; women; iron balance; serum ferritin; menstruation, Introduction Maintenance of iron balance, when absorption equals losses, is achieved by control of iron absorption since the body has no mechanisms to control iron losses. This was pointed out [...]

Iron stores in individuals and their rates of changes in relation to dietary iron intake and bioavailability as well as iron requirements were investigated. Amounts of stored iron and rate of growth of such stores in participants were calculated under different conditions. Results showed that differences in dietary iron intake and bioavailability and iron requirements affect the amounts of iron stores in the human body. Furthermore, there is a tendency for fast growth of iron stores during the first year and a slowdown in growth rate for the second and third years.

A study was conducted to examine the effect of a preceding mild infection on serum ferritin values by comparing the distribution of serum ferritin in those with and without a preceding infection in the last month. Results revealed that the prevalence of a recent infection is important in evaluating the prevalence of iron deficiency on the basis of serum ferritin measurements and in determining relationships between iron status and composition of the diet. The differences in prevalence of iron deficiency may be attributed to differences in prevalence of respiratory infections.

Reanalysis of the data on iron balance in 203 38-year-old women, originally surveyed in 1968-1969 in Goteborg, Sweden, revealed inverse correlations between iron absorption and measures of iron status, including serum ferritin and transferrin saturation levels. The regulation of iron absorption was determined to be a non-stop process to meet the low or high iron requirements of the subjects.

Hypoferremia is a well-known response to infections and inflammatory disorders. It seems to be managed by the key mediator of iron kinetics, hepcidin. There are several studies on induced-acute phase reactions. However, to our best knowledge there are no previous published reports on the outbreak of a common cold and its initial effect on iron kinetics. The objective of this case report is to describe such an observation. From an apparently healthy state in the morning we observed, in a 28-year-old male, every hour for 6 h the outbreak of a common cold and the modulations in the levels of serum iron (S-Fe) and interleukin-6 (IL-6). Despite a 100 mg oral iron loading there was a substantial reduction in S-Fe, which seemed to precede the IL-6 peak. Interestingly, this observed succession is in conflict with the proposed infection chain of order in which IL-6 stimulates hepcidin induction. European Journal of Clinical Nutrition (2007) 61, 1032-1034; doi: 10.1038/sj.ejcn.1602614; published online 31 January 2007 Keywords: iron, serum iron concentration, interleukin-6, infection, inflammation, hepcidin, Author(s): M Hoppe [1]; L Hulthen [1] Introduction Hypoferremia is a common response to infections and inflammatory disorders (Beresford et al., 1971). The underlying mechanisms are reduced iron absorption from [...]

Objective: To investigate how total daily energy expenditure (TEE) changes when underweight patients with chronic obstructive pulmonary disease (COPD) enters a physiotherapy programme. Design: Prospective intervention study. Setting: Sahlgrenska University Hospital, G#246;teborg, Sweden. Subjects: Fifteen patients with severe COPD and BMI [less than] 21 kg/m[sup.2] were recruited consecutively at the outpatient COPD unit at the Department of Respiratory Medicine. Fourteen patients completed the whole study. Intervention: TEE was assessed by the doubly labelled water method in a 2-week control period and during 2 weeks of physiotherapy. Energy intake was assessed using 7-day dietary record during control and physiotherapy period. Results: Mean TEE during physiotherapy period was 500 kJ (6%) lower than during control period but the difference was not statistically significant. Ten of the 14 patients had lower and four had higher TEE. Mean energy intake during the physiotherapy period did not change from the control period (7700 vs 7600 kJ/day). Conclusions: Since underweight patients with COPD may show variable TEE during physiotherapy compared to a control period, an assessment of individual energy requirements is recommended. Sponsorship: The Swedish Heart Lung Foundation, The Swedish Heart and Lung Association, The Swedish Nutrition Foundation, The Ingabritt and Arne Lundberg Foundation. European Journal of Clinical Nutrition (2006) 60, 870-876. doi: 10.1038/sj.ejcn.1602392; published online 1 February 2006 Keywords: doubly labelled water, underweight, energy intake, nutrition, rehabilitation, Author(s): F Slinde [1]; K Kvarnhult [2, 3]; A M Gronberg [2]; A Nordenson [2]; S Larsson [2]; L Hulthen [1] Introduction Chronic obstructive pulmonary disease (COPD) is a disease [...]

Objective: To validate a physical activity questionnaire for adolescents (PAQA) adapted from the International Physical Activity Questionnaire (IPAQ). Design: Energy expenditure was measured during a 14-day period with doubly labelled water (DLW). PAQA was administered as an interview at the end of the period, asking for physical activity in school, during transportation and leisure-time, during a habitual week. Energy expenditure (EE[sub.PAQA]) was calculated as the product of total physical activity+sleep and predicted resting metabolic rate, and was compared to energy expenditure from DLW (EE[sub.DLW]), thermic effect of feeding excluded. Setting: Participants were recruited from grade 9 in a compulsory school in G#246;teborg, Sweden. All data were collected at school, and distribution of DLW and measuring of resting metabolic rate were performed at Sahlgrenska University Hospital. Subjects: A total of 33 adolescents (16 girls, 17 boys) 15.7 (0.4) y performed all measurements. Results: For the whole group, PAQA underestimated energy expenditure by 3.8 (1.7) MJ (P [less than] 0.001). There was a strong correlation (r=0.62, P [less than] 0.001) between EE[sub.PAQA] and EE[sub.DLW], but not for boys (r=0.42, P=0.090) and girls (r=0.33, P=0.22) separately. Conclusions: PAQA is not able to predict energy expenditure in Swedish adolescents, largely explained by the amount of unreported time. The ability to rank adolescents energy expenditure is questioned because of the gender effect, although we found a strong correlation for the whole group. Sponsorship: Ingabritt and Arne Lundberg Foundation. European Journal of Clinical Nutrition (2005) 59:, 376-383. doi: 10.1038/sj.ejcn.1602084 Published online 10 November 2004 Keywords: physical activity questionnaire, energy expenditure, validation, adolescents, Author(s): D Arvidsson [1]; F Slinde [1]; L Hulthen [1] Introduction Obesity is increasing worldwide and in the more affluent countries it is now common even in children and adolescents [...]

Objective:: To compare the diet history (DH) method to an estimated 7-day record (7-d) concerning meal pattern and intake of foods, energy and nutrients. Design:: After the DH interview, subjects completed the 7-d. Setting:: School setting, G#246;teborg, Sweden. Subjects:: A total of 51 adolescent girls (15-16 y) recruited from 634 girls participating in The G#246;teborg Adolescence Study. Results:: Two-thirds of the girls had identical or similar main meal pattern, while the number of in-between meals was higher using DH (P [less than] 0.001). Breakfast was the meal that agreed best and dinner during weekends. Energy intake (EI) was 8% higher in DH compared to 7-d (P=0.056). The ratio EI to basal metabolic rate was 1.35 (1.14, 1.65) using DH and 1.26 (1.08, 1.52) using 7-d, indicating under-reporting in both methods. Intake of vegetables, juice, sweets, soft-drinks and jam did not differ between the methods, but for the rest of the intake DH estimates were higher (P [less than] 0.05). The calculated nutrient intake was higher by DH, with exception of fat and sucrose. For the main food groups, energy and nutrients, except alcohol, ranking was similar between the methods. Adjusted for EI (10 MJ), intake of fat and sucrose were lower and protein, calcium and fibre were higher by DH (P [less than] 0.01). EI did not differ for lunch and dinner, but was higher in breakfast and in-between meals using DH. Intake of foods and nutrients in lunches and meat and fish for lunch and dinner did not differ. Conclusions:: The diet history seems to work well as a reference method for dietary assessments in this age group. Sponsorship:: The Swedish Medical Research Council (project B94-19X-04721-19A), the Swedish Mill Industry, The Wilhelm and Martina Lundgren Foundation and The Swedish Nutrition Foundation. European Journal of Clinical Nutrition (2004) 58, 1181-1189. doi: 10.1038/sj.ejcn.1601947 Published online 31 March 2004 Keywords: diet survey, interview, food habits, diet record, evaluation studies, adolescent nutrition, Author(s): A Sjoberg [1]; L Hulthen [1] Introduction Assessment of food habits is central for studies of the relation between diet and health, and it is important that dietary methods [...]

Objective:: To compare habitual energy intake (EI) estimated from diet history (DH) with total energy expenditure (TEE) measured with doubly labelled water (DLW) in adolescents. Design:: DH included a detailed questionnaire and an interview. TEE was measured during a 14-day period. Adequate (AR), under- (UR) and over-reporters (OR) were defined from the ratio EI/TEE: AR 0.84-1.16, UR [less than] 0.84 and OR [greater than] 1.16. Setting:: Participants were recruited from grade 9 in a compulsory school in G#246;teborg, Sweden. All data were collected at school and DLW dosages were distributed at Sahlgrenska University Hospital. Subjects:: A total of 35 adolescents (18 boys, 17 girls), 15.7 (0.4) y. Results:: EI was 11.0 (3.6) MJ and TEE was 11.4 (2.1) MJ (P=0.42). DH was able to rank EI compared to TEE (Spearman&apos;s r=0.59, P[les]0.001). For girls, EI was 18% lower (P=0.0067) and for boys, EI was 7% higher (P=0.26) compared to TEE. The 95% limits of agreement for difference between TEE and EI were -5.6 to 6.5 MJ. In total, 20 subjects were defined as AR (57%), nine as UR (26%) and six as OR (17%). Energy from in-between meals was 33% lower (P=0.0043) in UR girls and 57% higher (P=0.026) in OR boys, compared to adequate reporting girls and boys, respectively. In UR girls, energy-adjusted intake (10 MJ) of specific foods did not differ significantly, fat was lower and carbohydrate and vitamin C were higher compared to AR girls (all P [less than] 0.05). OR boys had no significant differences in food and nutrient intake in 10 MJ compared to AR boys. Conclusion:: The diet history was able to capture EI for the group and to rank subjects. There was a wide individual range in reporting- accuracy related to gender. Sponsorship:: The Ingabritt and Arne Lundberg Foundation, The Wilhelm and Martina Lundgren Foundation. European Journal of Clinical Nutrition (2003) 57, 1643-1652. doi: 10.1038/sj.ejcn.1601892 Keywords: energy intake, energy expenditure, doubly labelled water, adolescent nutrition, food habits, Author(s): A Sjoberg [1]; F Slinde [1]; D Arvidsson [1]; L Ellegard [1]; E Gramatkovski [1]; L Hallberg [1]; L Hulthen [1] Introduction Valid dietary assessment methods are important to [...]

Objective:: To relate meal pattern of Swedish adolescents to food choice, nutrient intake and other lifestyle factors. Design:: Cross-sectional study including diet history and interview about smoking, ethnicity, social factors and retrospectively collected data of menarche and growth. Setting:: School setting, G#246;teborg, Sweden. Subjects:: A total of 611 boys and 634 girls in grade 9 (15-16 y). Results:: The majority of the students, 65% of the boys and 52% of the girls, consumed three main meals daily. The in-between meals, however, contributed the major part of the energy intake. The energy intake was 12.9[plus or minus]3.5 MJ (mean[plus or minus]s.d.) for boys and 9.0[plus or minus]2.5 MJ for girls. Irregular breakfast eating, 12% of the boys and 24% of the girls, was related to negative lifestyle factors where smoking was the strongest, odds ratio 3.8 (95% CI: 2.6-5.4) and to irregular intake of lunch and dinner. These boys and girls had a food choice including a higher percentage of energy from snack food (26% vs 20% and 19% in boys and girls respectively, all P [less than] 0.001), mostly consumed between the main meals. These groups had significantly lower intakes of micronutrients, but higher intakes of sucrose and alcohol compared to the groups with regular breakfast intake. Girls omitting breakfasts and lunches (8%) also had a less healthy food choice and the poorest nutrient intake. These girls had matured earlier, with menarche age of 12.2[plus or minus]1.1 y vs 12.9[plus or minus]1.0 y (P [less than] 0.001) in girls with regular main meal intake. Conclusions:: Meal pattern with omission of breakfast or breakfast and lunch was related to a clustering of less healthy lifestyle factors and food choice leading to a poorer nutrient intake. Sponsorship:: The Swedish Medical Research Council (project B94-19X-04721-19A), the Swedish Mill Industry and the Wilhelm and Martina Lundgren Foundation. European Journal of Clinical Nutrition (2003) 57, 1569-1578. doi: 10.1038/sj.ejcn.1601726 Keywords: adolescent nutrition, diet surveys, interviews, food habits, energy intake, breakfast, Author(s): A Sjoberg [1]; L Hallberg [1]; D Hoglund [2]; L Hulthen [1] Introduction The food habits of adolescents are of concern since this vulnerable group has greater energy and [...]

Objective:: To study whether hydrothermal treatment or malting of barley (cv. Blenheim) improves zinc and calcium absorption in humans. Design:: Two groups of 10 and 12 healthy subjects, respectively, were in a period of 2 months in a fasting state, served two single meals each containing porridge or breakfast cereals prepared from processed or unprocessed (control) barley (60 g). The meals included 200 g of milk, extrinsically labelled with [sup.65]Zn and [sup.47]Ca. Whole-body retention of both minerals was measured. Setting:: The study was carried out at the Department of Radiation Physics, Sahlgrenska University Hospital, G#246;teborg. Subjects:: The subjects were recruited among students at the G#246;teborg University. None dropped out. Interventions:: The activities of [sup.65]Zn and [sup.47]Ca were measured by whole-body counting four to five times over a 4-week period after each meal. Results:: Zinc absorption from hydrothermally treated barley porridge, containing 28 mg P as inositol tri- to hexaphosphates (InsP[sub.3]-InsP[sub.6]), was significantly higher (P [less than] 0.001) than from control porridge containing 111 mg P as InsP[sub.3]-InsP[sub.6], 25.2[plus or minus]6.9 vs 11.0[plus or minus]2.5% (n=12). Calcium absorption did not differ (P [greater than] 0.05), 21.1[plus or minus]6.8 vs 19.5[plus or minus]4.7% (n=12). Zinc absorption from breakfast cereals of malted barley with phytase activity and containing 70 mg P as InsP[sub.3]-InsP[sub.6,] was significantly higher (P [less than] 0.05) than from flakes of barley, containing 108 mg P as InsP[sub.3]- InsP[sub.6] and no phytase activity, 22.9[plus or minus]5.8 vs 14.8[plus or minus]4.6% (n=10). The calcium absorption was 21.3[plus or minus]6.5 vs 18.5[plus or minus]4.3% (n=10) and did not differ significantly (P [greater than] 0.05). Conclusions:: Improvements of zinc absorption in breakfast meals can be achieved by optimised hydrothermal treatment or malting of barley. Calcium absorption was not influenced in the meals in this study. Sponsorship:: Supported by Semper AB, Sweden, Oy Lahden Polttimo, Finland, the SL-Foundation, Sweden, Swedish National Board for Industrial and Technical Development (NUTEK), the Nordic Industrial Foundation, Swedish Council for Forestry and Agricultural Research (SJFR, project no 50.0306/97). European Journal of Clinical Nutrition (2003) 57, 1507-1513. doi: 10.1038/sj.ejcn.1601718 Keywords: phytate, InsP[sub.6], barley, hydrothermal treatment, zinc absorption, calcium absorption, whole-body counting, Author(s): K Fredlund [1]; E-L Bergman [1]; L Rossander-Hulthen [2]; M Isaksson [3]; A Almgren [2]; A-S Sandberg [1] Introduction Cereals contribute significant quantities of minerals to the human diet. [...]

Correction to: European Journal of Clinical Nutrition (2008) 62, 761-769; doi:10.1038/sj.ejcn.1602776; published online 30 May 2007 Since the publication of this paper, the authors have noticed that there are missing [...]

Background: Iron fortification of wheat flour is widely used as a strategy to combat iron deficiency.Objective: To review recent efficacy studies and update the guidelines for the iron fortification of wheat flour.Methods: Efficacy studies with a variety of iron-fortified foods were reviewed to determine the minimum daily amounts of additional iron that have been shown to meaningfully improve iron status in children, adolescents, and women of reproductive age. Recommendations were computed by determining the fortification levels needed to provide these additional quantities of iron each day in three different wheat flour consumption patterns. Current wheat flour iron fortification programs in 78 countries were evaluated.Results: When average daily consumption of low-extraction (< or = 0.8% ash) wheat flour is 150 to 300 g, it is recommended to add 20 ppm iron as NaFeEDTA, or 30 ppm as dried ferrous sulfate or ferrous fumarate. If sensory changes or cost limits the use of these compounds, electrolytic iron at 60 ppm is the second choice. Corresponding fortification levels were calculated for wheat flour intakes of < 150 g/day and > 300 g/day. Electrolytic iron is not recommended for flour intakes of < 150 g/day. Encapsulated ferrous sulfate or fumarate can be added at the same concentrations as the non-encapsulated compounds. For high-extraction wheat flour (> 0.8% ash), NaFeEDTA is the only iron compound recommended. Only nine national programs (Argentina, Chile, Egypt, Iran, Jordan, Lebanon, Syria, Turkmenistan, and Uruguay) were judged likely to have a significant positive impact on iron status if coverage is optimized. Most countries use non-recommended, low-bioavailability, atomized, reduced or hydrogen-reduced iron powders.Conclusion: Most current iron fortification programs are likely to be ineffective. Legislation needs updating in many countries so that flour is fortified with adequate levels of the recommended iron compounds. [ABSTRACT FROM AUTHOR]

Silicon is a trace element found mainly in plant-based food and proposed to be beneficial for bone health. Urinary excretion of Si has been shown to be a surrogate measure of its uptake in the gastrointestinal tract. The objective of this study was to describe and compare the levels of urinary Si excretion, and consequently Si uptake, in Swedish men, non-pregnant women, and pregnant women. No formal assessment of dietary Si intake was carried out in this study. This cross-sectional study included 89 men, 42 non-pregnant women, and 60 pregnant women. The subjects collected urine over a 24-h period and the samples were assayed for total Si using inductively coupled plasma optical emission spectrometry. The excretion levels of creatinine were used to validate the completeness of the urine sample collections. The mean 24-h urinary excretions of Si were 7.8 mg for the cohort of young men, 7.6 mg for the cohort of non-pregnant women, and 12.4 mg for the cohort of pregnant women. Creatinine excretion was similar between pregnant and non-pregnant women (10.4 vs. 10.8 mmol/day) and significantly higher in men (15.4 mmol/day). The pregnant women excreted significantly higher levels of Si than the young men and non-pregnant women, respectively (p < 0.05). The higher urinary excretion of Si by pregnant women compared with men and non-pregnant women is a novel finding possibly caused by temporary physiological changes during pregnancy such as increased gastrointestinal uptake of Si, altered bone metabolism, and increased renal excretion of Si.

Introduction: Iodine is essential for normal brain development. Moderate and severe fetal iodine deficiency results in substantial to serious developmental delay in children. Mild iodine deficiency in pregnancy is associated with neurodevelopmental deficits in the offspring, but evidence from randomised trials is lacking. The aim of the Swedish Iodine in Pregnancy and Development in Children study is to determine the effect of daily supplementation with 150 µg iodine during pregnancy on the offspring's neuropsychological development up to 14 years of age., Methods and Analysis: Thyroid healthy pregnant women (n=1275: age range 18-40 years) at ≤12 weeks gestation will be randomly assigned to receive multivitamin supplements containing 150 µg iodine or non-iodine-containing multivitamin daily throughout pregnancy. As a primary outcome, IQ will be measured in the offspring at 7 years (Wechsler Intelligence Scale for Children-V). As secondary outcomes, IQ will be measured at 3.5 and 14 years, psychomotor development at 18 months and 7 years, and behaviour at 3.5, 7 and 14 years. Iodine status (urinary iodine concentration) will be measured during pregnancy and in the offspring at 3.5, 7 and 14 years. Thyroid function (thyroid hormones, thyroglobulin), and deiodinase type 2 polymorphisms will be measured during pregnancy and in the offspring at 7 and 14 years. Structural MRI or other relevant structural or functional brain imaging procedures will be performed in a subgroup of children at 7 and 14 years. Background and socioeconomic information will be collected at all follow-up times., Ethics and Dissemination: This study is approved by the Ethics Committee in Göteborg, Sweden (Diary numbers: 431-12 approved 18 June 2012 (pregnancy part) and 1089-16 approved 8 February 2017 (children follow-up)). According to Swedish regulations, dietary supplements are governed by the National Food Agency and not by the Medical Product Agency. Therefore, there is no requirement for a monitoring committee and the National Food Agency does not perform any audits of trial conduct. The trial will be conducted in accordance with the Declaration of Helsinki. The participating sites will be contacted regarding important protocol changes, both orally and in writing, and the trial registry database will be updated accordingly. Study results will be presented at relevant conferences, and submitted to peer-reviewed journals with open access in the fields of endocrinology, paediatrics and nutrition. After the appropriate embargo period, the results will be communicated to participants, healthcare professionals at the maternal healthcare centres, the public and other relevant groups, such as the national guideline group for thyroid and pregnancy and the National Food Agency., Trial Registration Number: NCT02378246; Pre-results., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Lactic fermentation of foods increases the availability of iron as shown in a number of studies throughout the years. Several explanations have been provided such as decreased content of inhibitory phytate, increased solubility of iron, and increased content of lactic acid in the fermented product. However, to our knowledge, there are no data to support that the bioavailability of iron is affected by lactic fermentation., Objectives: The objective of the present study was to investigate whether the bioavailability of iron from a vegetable mix was affected by lactic fermentation and to propose a mechanism for such an event, by conducting human and cell (Caco-2, HepG2) studies and iron speciation measurements (voltammetry). We also investigated whether the absorption of zinc was affected by the lactic fermentation., Results: In human subjects, we observed that lactic-fermented vegetables served with both a high-phytate and low-phytate meal increased the absorption of iron, but not zinc. In vitro digested fermented vegetables were able to provoke a greater hepcidin response per ng Fe than fresh vegetables, indicating that Fe in the fermented mixes was more bioavailable, independent on the soluble Fe content. We measured that hydrated Fe(3+) species were increased after the lactic fermentation, while there was no significant change in hydrated Fe(2+). Furthermore, lactate addition to Caco-2 cells did not affect ferritin formation in response to Fe nor did lactate affect the hepcidin response in the Caco-2/HepG2 cell system., Conclusions: The mechanism for the increased bioavailability of iron from lactic-fermented vegetables is likely an effect of the increase in ferric iron (Fe(3+)) species caused by the lactic fermentation. No effect on zinc bioavailability was observed.

Depression is a common and serious disorder that may have developmental origins. Birth-related factors have been related to childhood and adult occurrence of somatic as well as psychiatric disorders, but studies on the relationship between birth-related factors and depression are few and show mixed results. In addition, varying methods have been used to assess depression. Standardized clinical criteria to diagnose depression, combined with birth data collected from midwife records have not been used in most studies. Participants in the Prospective Population Study of Women in Sweden (803 women), born 1914, 1918, 1922 and 1930, provide information on birth factors and depression. Women participated from 1968 at mid-life ages of 38-60 years, to 2000, when they were age 78-92 years. Original birth records containing birth weight, length, head circumference, and gestational time, as well as social factors were obtained. Lifetime depression was diagnosed via multiple information sources. Symptoms were assessed using the Comprehensive Psychopathological Rating Scale and diagnoses were based on DSM-III-R criteria. Over their lifetime, 44.6% of women in this sample experienced depression. Birth weights ≤ 3500 g [odds ratio (OR), age-adjusted = 1.72; 95% CI 1.29-2.28, P < 0.001] and shorter gestational time (OR, age-adjusted = 1.13; 95% CI 1.04-1.24, P = 0.005) were independently associated with a higher odds of lifetime depression in a logistic regression model adjusted for age. Lower than median birth weights and shorter gestational time were related to lifetime depression in women. Both neurodevelopmental and environmental contributions to lifetime depression may be considered.