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A comprehensive overview is presented of the nutritional issues faced by people who use drugs or are undergoing treatment for recovery. Chronic substance use affects a person's nutritional status and body composition through decreased intake, nutrient absorption, and dysregulation of hormones that alter the mechanisms of satiety and food intake. Anthropometrics alone is not the best indicator of nutritional status, because this population has hidden deficiencies and disturbed metabolic parameters. Socioeconomic factors (eg, higher education, higher income, presence of a partner, living at home) positively affect nutritional status. Scarce available data on users undergoing treatment indicate improvement in anthropometric and metabolic parameters but with micronutrient intake remaining suboptimal. Weight gain is noted especially among women who use drugs and potentially increases their risk of relapse. Finally, specific amino acids and omega-3 fatty acids are promising in decreasing relapse and improving mental health during treatment; however, additional high-quality studies are needed. Nutrition intervention for people who use drugs or are undergoing treatment for recovery is underused; comprehensive programs addressing this population's unique needs are necessary. Future research will identify which components are needed.

A comprehensive overview is presented of the nutritional issues faced by people who use drugs or are undergoing treatment for recovery. Chronic substance use affects a person’s nutritional status and body composition through decreased intake, nutrient absorption, and dysregulation of hormones that alter the mechanisms of satiety and food intake. Anthropometrics alone is not the best indicator of nutritional status, because this population has hidden deficiencies and disturbed metabolic parameters. Socioeconomic factors (eg, higher education, higher income, presence of a partner, living at home) positively affect nutritional status. Scarce available data on users undergoing treatment indicate improvement in anthropometric and metabolic parameters but with micronutrient intake remaining suboptimal. Weight gain is noted especially among women who use drugs and potentially increases their risk of relapse. Finally, specific amino acids and omega-3 fatty acids are promising in decreasing relapse and improving mental health during treatment; however, additional high-quality studies are needed. Nutrition intervention for people who use drugs or are undergoing treatment for recovery is underused; comprehensive programs addressing this population’s unique needs are necessary. Future research will identify which components are needed.

Cheese and butter have been shown to affect blood lipids differently. This parallel-arm, randomised, controlled study in 36 crossbred growing sows compared the effect of diets with either regular-fat cheese (REG), reduced-fat cheese + butter (RED) or butter (BUT) on blood lipids, faecal fat and energy excretion and gut microbiome in pigs. A 14-d run-in period was followed by 14-d interventions with macronutrient-matched diets. Fasting total cholesterol and HDL-cholesterol after 14 days were higher in REG compared with BUT, but only tended to be higher in RED. Compared with BUT, REG and RED had higher faecal fat excretion. Faecal energy excretion was only higher in REG, and this correlated with a lower microbiome Firmicutes-to-Bacteroidetes ratio. In conclusion, dairy fat consumed as cheese or butter caused different metabolic effects. Differences between reduced-fat cheese+butter and butter were less pronounced than differences between regular-fat cheese and butter, suggesting an impact of the dairy-matrix.

About 30 years ago, the first Dutch unifactorial guidelines on hypertension and hypercholesterolaemia were developed. These guidelines have been revised several times, often after publication of landmark studies on new generations of drugs. In 1978, cut-off points for pharmacological treatment of hypertension were based on diastolic blood pressure values =115 mmHg, and in 2000 they were lowered to >100 mmHg. From 1997 onwards, cut-off points for systolic blood pressure values >180 mmHg were introduced, which became leading. In 1987, cut-offs for hypercholesterolaemia of =8 mmol/l were set and from 2006 pharmacological treatment was based on a total/HDL cholesterol ratio >8. Around 2000, treatment decisions for hypertension and/or hypercholesterolaemia were no longer based on high levels of individual risk factors, but on a multifactorial approach based on total risk of cardiovascular diseases (CVD), determined by a risk function. In the 2006 multidisciplinary guideline on cardiovascular risk management, the Framingham risk tables were replaced by European SCORE risk charts. A cut-off point of 10% CVD mortality was set in the Netherlands. In 2011, this cut-off point changed to 20% fatal plus nonfatal CVD risk. Nowadays, ‘the lower the risk factors, the lower the absolute risk’ is the leading paradigm in CVD prevention.

International audience; Recent studies have demonstrated the value of non-fasting serum triglycerides (TG) as risk markers for cardiovascular and cerebrovascular disease. This underscores the importance of knowing the postprandial lipid/lipoprotein responses to different foods. A systematic approach is needed to make use of postprandial lipid data as a practical nutritional tool, similar to the well known glycemic index (GI), which is a measure of the effect of carbohydrates on blood glucose levels. Using GI as a model, we propose that a similar and parallel nutritional tool called Lipemic Index (LI) be developed to facilitate the planning of a healthy diet. LI could also serve as a tool in human nutrition research. LI would refer to the postprandial increase of serum TG after a test meal with a specific food relative to a reference meal. The reference meal could take the form of a fat load that has a fixed amount (e. g. 50-70 g) of a mixture of saturated, polyunsaturated and monounsaturated fats in known proportions. It is possible that a test meal may have a greater degree of postprandial lipemia (PPL) than the reference meal and, unlike GI, the LI may exceed 100%. We recommend total plasma TG as the blood parameter to follow after consumption of the fat load. The TG incremental area under the curve (iAUC) will be calculated from the curve drawn from hourly measurements of plasma TG up to 6 hours using the trapezoid rule. The LI of the test meal (%) will equal the iAUC of the test meal divided by the iAUC of the reference meal x 100. Consideration will be given to the impact of background diet, other nutrients in the test meal and gender differences on LI testing. The establishment of LI into practice will be complicated and challenging. However, it is important for work to begin on establishing a practical and quantifiable index of PPL, in order to benefit clinical management of patients as well as research.

Background: During the past two decades, the hypothesis of fetal origins of adult disease has received considerable attention. However, critique has also been raised regarding the failure to take the explanatory role of accumulation of other exposures into consideration, despite the wealth of evidence that social circumstances during the life course impact on health in adulthood. The aim of the present prospective cohort study was to examine the contributions of birth weight and life course exposures (cumulative socioeconomic disadvantage and adversity) to dyslipidemia and serum lipids in mid-adulthood. Methods: A cohort (effective n = 824, 77%) was prospectively examined with respect to self-reported socioeconomic status as well as stressors (e.g., financial strain, low decision latitude, separation, death or illness of a close one, unemployment) at the ages of 16, 21, 30 and 43 years; summarized in cumulative socioeconomic disadvantage and cumulative adversity. Information on birth weight was collected from birth records. Participants were assessed for serum lipids (total cholesterol, low- and high-density lipoprotein cholesterol and triglycerides), apolipoproteins (A1 and B) and height and weight (for the calculation of body mass index, BMI) at age 43. Current health behavior (alcohol consumption, smoking and snuff use) was reported at age 43. Results: Cumulative life course exposures were related to several outcomes; mainly explained by cumulative socioeconomic disadvantage in the total sample (independently of current health behaviors but attenuated by current BMI) and also by cumulative adversity in women (partly explained by current health behavior but not by BMI). Birth weight was related only to triglycerides in women, independently of life course exposures, health behaviors and BMI. No significant association of either exposure was observed in men. Conclusions: Social circumstances during the life course seem to be of greater importance than birth weight for dyslipidemia and serum lipid levels in adulthood. Background Since the early 1990 s, the research field of life course epidemiology has studied the health effects of biological and social exposures during different periods of life and the corresponding long-term processes spanning over the life course [1]. One line of research focuses on fetal origins of disease, with one hypothesis stating that suboptimal metabolic conditions during fetal life, e.g. indicated by lower birth weight, increase the risk for cardiovascular disease in adulthood [2]. Low birth weight has been shown to be associated with cardiovascular mortality [3,4] and to predict a number of related disorders, such as hypertension, obesity and insulin resistance [5-7]. The fetal origins hypothesis has, however, been criticized for overestimation of effects [8] and failure to consider the wealth of other exposures between birth and adulthood. One of the challenges of studying the fetal origins hypothesis is how to incorporate confounding and explanatory effects of accumulated stress over the life span into the analyses [9], which is a manifest limitation of past and present research on the field. The present study will address this issue by examining the importance of birth weight as well as social

Foods and food components can have positive and/or negative effects on our health, resulting in benefits and risks. At present these are evaluated in largely separated trajectories. In view of assessment, management, and communication, we here propose and argue for an integrated evaluation of risk and benefit of food components and foods. The window of benefit assessment concept is described as a framework to combine thresholds and scores. The recommended dietary allowance (RDA) and the tolerable upper intake level (UL) delimit the range of intakes that should be considered sufficient to prevent deficiency, while avoiding toxicity. Within these thresholds, two additional thresholds, the lower and upper level of additional benefit (LLAB and ULAB), define the range of intakes that constitute an additional benefit. Intake within these limits should thus be protective against a specified health or nutritional risk of public health relevance. To faithfully predict outcomes and to obtain the tools that are necessary to support scientific valid evaluations, a mechanism based systems biology understanding of the effects of foods and nutrients is seen as the way forward. Ultimately this should lead to an integrated risk-benefit assessment, which will allow better management and, especially, communication, to the benefit of the consumer.

Background Insufficient PA has been shown to cluster with other CVD risk factors including insufficient fruit and vegetable intake, overweight, increased serum cholesterol concentrations and elevated blood pressure. This paper describes the development of Working on Wellness (WOW), a worksite intervention program incorporating motivational interviewing by wellness specialists, targeting employees at risk. In addition, we describe the evaluation the effectiveness of the intervention among employees at increased risk for cardiovascular disease. Methods The intervention mapping (IM) protocol was used in the planning and design of WOW. Focus group discussions and interviews with employees and managers identified the importance of addressing risk factors for CVD at the worksite. Based on the employees’ preference for individual counselling, and previous evidence of the effectiveness of this approach in the worksite setting, we decided to use motivational interviewing as part of the intervention strategy. Thus, as a cluster-randomised, controlled control trial, employees at increased risk for CVD (N = 928) will be assigned to a control or an intervention group, based on company random allocation. The sessions will include motivational interviewing techniques, comprised of two face-to-face and four telephonic sessions, with the primary aim to increase habitual levels of PA. Measures will take place at baseline, 6 and 12 months. Secondary outcomes include changes in nutritional habits, serum cholesterol and glucose concentrations, blood pressure and BMI. In addition, healthcare expenditure and absenteeism will be measured for the economic evaluation. Analysis of variance will be performed to determine whether there were significant changes in physical activity habits in the intervention and control groups at 6 and 12 months. Discussion The formative work on which this intervention is based suggests that the strategy of targeting employees at increased risk for CVD is preferred. Importantly, this study extends the work of a previous, similar study, Health Under Construction, in a different setting. Finally, this study will allow an economic evaluation of the intervention that will be an important outcome for health care funders, who ultimately will be responsible for implementation of such an intervention. Trial registration United States Clinical Trails Register NCT 01494207