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issn:1654-661
1.  Dietary strawberry seed oil affects metabolite formation in the distal intestine and ameliorates lipid metabolism in rats fed an obesogenic diet 
Food & Nutrition Research  2015;59:10.3402/fnr.v59.26104.
Objective
To answer the question whether dietary strawberry seed oil rich in α-linolenic acid and linoleic acid (29.3 and 47.2% of total fatty acids, respectively) can beneficially affect disorders induced by the consumption of an obesogenic diet.
Design
Thirty-two male Wistar rats were randomly assigned to four groups of eight animals each and fed with a basal or obesogenic (high in fat and low in fiber) diet that contained either strawberry seed oil or an edible rapeseed oil. A two-way analysis of variance was then applied to assess the effects of diet and oil and the interaction between them.
Results
After 8 weeks of feeding, the obesogenic diet increased the body weight and the liver mass and fat content, whereas decreased the cecal acetate and butyrate concentration. This diet also altered the plasma lipid profile and decreased the liver sterol regulatory element-binding protein 1c (SREBP-1c) content. However, the lowest liver SREBP-1c content was observed in rats fed an obesogenic diet containing strawberry seed oil. Moreover, dietary strawberry seed oil decreased the cecal short-chain fatty acid concentrations (acetate, propionate, and butyrate) regardless of the diet type, whereas the cecal β-glucuronidase activity was considerably increased only in rats fed an obesogenic diet containing strawberry seed oil. Dietary strawberry seed oil also lowered the liver fat content, the plasma triglyceride level and the atherogenic index of plasma.
Conclusions
Strawberry seed oil has a potent lipid-lowering activity but can unfavorably affect microbial metabolism in the distal intestine. The observed effects are partly due to the synergistic action of the oil and the obesogenic diet.
doi:10.3402/fnr.v59.26104
PMCID: PMC4312358  PMID: 25636326
α-linolenic acid; butyrate; cecum; linoleic acid; strawberry seed oil; triglycerides
2.  Addressing the risk of inadequate and excessive micronutrient intakes: traditional versus new approaches to setting adequate and safe micronutrient levels in foods 
Food & Nutrition Research  2015;59:10.3402/fnr.v59.26020.
Fortification of foods consumed by the general population or specific food products or supplements designed to be consumed by vulnerable target groups is amongst the strategies in developing countries to address micronutrient deficiencies. Any strategy aimed at dietary change needs careful consideration, ensuring the needs of at-risk subgroups are met whilst ensuring safety within the general population. This paper reviews the key principles of two main assessment approaches that may assist developing countries in deciding on effective and safe micronutrient levels in foods or special products designed to address micronutrient deficiencies, that is, the cut-point method and the stepwise approach to risk–benefit assessment. In the first approach, the goal is to shift population intake distributions such that intake prevalences below the Estimated Average Requirement (EAR) and above the Tolerable Upper Intake Level (UL) are both minimized. However, for some micronutrients like vitamin A and zinc, a narrow margin between the EAR and UL exists. Increasing their intakes through mass fortification may pose a dilemma; not permitting the UL to be exceeded provides assurance about the safety within the population but can potentially leave a proportion of the target population with unmet needs, or vice versa. Risk–benefit approaches assist in decision making at different micronutrient intake scenarios by balancing the magnitude of potential health benefits of reducing inadequate intakes against health risks of excessive intakes. Risk–benefit approaches consider different aspects of health risk including severity and number of people affected. This approach reduces the uncertainty for policy makers as compared to classic cut-point methods.
doi:10.3402/fnr.v59.26020
PMCID: PMC4309831  PMID: 25630617
food fortification; nutrient reference values; requirements; cut-point method; risk–benefit assessment; public health
3.  Food choices, perceptions of healthiness, and eating motives of self-identified followers of a low-carbohydrate diet 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.23552.
Background
Low-carbohydrate (LC) diets have gained substantial media coverage in many Western countries. Little is, however, known about the characteristics of their followers.
Objective
The article analyses how those who report following an LC diet differ from the rest of the population in their background, food choices, weight reduction status, as well as food-related perceptions and motives. The data are a part of the Health Behaviour and Health among the Finnish Adult Population survey collected in spring 2012 (n=2,601), covering 15- to 64-year-old Finns.
Results
Seven per cent of the respondents identified themselves as followers of the LC diet. Gender and education were not associated with following an LC diet. The youngest respondents were the least likely to follow such a diet. The LC diet group preferred butter but also vegetables more commonly than the other respondents and were less likely to use vegetable bread spreads. The followers of the LC diet and the other respondents agreed about the healthiness of whole grain, vegetable oils, vegetables, and fruits and berries, and of the harmfulness of white wheat. Compared to the other respondents, the LC diet group was less likely to regard eating vegetable/low-fat products as important, more likely to regard eating healthy carbohydrates, and the health and weight-managing aspects of foods, as important and placed less value on sociability and pleasures connected to food. The results showed varying food choices among the followers of the LC diet: some even reported that they were not avoiding carbohydrates, sugars, and white wheat in their diet.
Conclusions
Planners of nutrition policies should follow-up on new diets as they emerge and explore the food choices and motives of their followers and how these diets affect the food choices of the whole population.
doi:10.3402/fnr.v58.23552
PMCID: PMC4258637  PMID: 25490960
low-carbohydrate diet; food choices; fats; carbohydrates; motives; perceptions; health risks; weight management; pleasure
4.  Relative validity and reproducibility of a food frequency questionnaire to assess dietary fiber intake in Danish adults 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.24723.
Background
Differences in habitual dietary fiber intake may modify effects of dietary fiber interventions, thus measurement of habitual dietary fiber intake is relevant to apply in intervention studies on fiber-rich foods, and food frequency questionnaire (FFQ) is a commonly used method. Rye bread is the major contributor of dietary fiber in the Danish population, and a nation-specific FFQ is therefore needed.
Objective
The aim of this study was to assess the relative validity and reproducibility of a self-administered quantitative FFQ designed to assess total dietary fiber intake among Danish adults.
Design
In order to assess the relative validity of the FFQ, a total of 125 participants completed both a 7-day weighed dietary recording (DR) and an FFQ consisting of 60 questions. To evaluate the reproducibility of the FFQ, a sub-group of 12 participants subsequently completed an FFQ approximately 6 months later.
Results
Estimates of mean dietary fiber intake were 24.9±9.8 and 28.1±9.4 g/day when applying the FFQ and DR, respectively, where FFQ estimates were ~12% lower (p<0.001). Pearson's correlation coefficient between the estimated dietary fiber intake of the two methods was r=0.63 (p<0.001), and 62% of the participants were grouped into the same tertile of intake according to the two methods. The estimates of mean dietary intake of first and second FFQ were very similar (22.2±4.0 and 23.3±4.1 g/day, respectively, p=0.42) and showed a correlation of r=0.95 (95% CI 0.83–0.99).
Conclusion
The developed FFQ showed moderate underestimation of dietary fiber intake (g/day), adequate ranking of subjects according to their dietary fiber intake, and good reproducibility. The FFQ is therefore believed to be a valuable tool for epidemiology and screening in human interventions, where intake of dietary fibers is of specific interest.
doi:10.3402/fnr.v58.24723
PMCID: PMC4258638  PMID: 25490961
nutrient intake; dietary fiber; cereal fiber; fruit and vegetable fiber; food frequency questionnaire; validation; reproducibility; Danish population
5.  Influence of a healthy Nordic diet on serum fatty acid composition and associations with blood lipoproteins – results from the NORDIET study 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.24114.
Background
The fatty acid (FA) composition of serum lipids is related to the quality of dietary fat intake.
Objective
To investigate the effects of a healthy Nordic diet (ND) on the FA composition of serum cholesterol esters (CE-FA) and assess the associations between changes in the serum CE-FA composition and blood lipoproteins during a controlled dietary intervention.
Design
The NORDIET trial was a 6-week randomised, controlled, parallel-group dietary intervention study that included 86 adults (53±8 years) with elevated low-density lipoprotein cholesterol (LDL-C). Serum CE-FA composition was measured using gas chromatography. Diet history interviews were conducted, and daily intake was assessed using checklists.
Results
Food and nutrient intake data indicated that there was a reduction in the intake of fat from dairy and meat products and an increase in the consumption of fatty fish with the ND. The levels of saturated fatty acids in cholesterol esters (CE-SFA) 14:0, 15:0, and 18:0, but not 16:0, showed a significant decrease after intake of ND compared to the control diet (p<0.01). Also, a significant increase in serum 22:6n – 3 was observed compared with the control diet (p<0.01). The changes in CE-SFA 14:0, 15:0, and 18:0 correlated positively with changes in LDL-C, HDL-C, LDL-C/HDL-C, ApoA1, and ApoB (p<0.01), respectively, whereas the changes in polyunsaturated fatty acids in cholesterol esters (CE-PUFA) 22:6n – 3 were negatively correlated with changes in the corresponding serum lipids.
Conclusions
The decreased intake of saturated fat and increased intake of n-3 PUFA in a healthy ND is partly reflected by changes in the serum CE-FA composition, which are associated with an improved serum lipoprotein pattern.
doi:10.3402/fnr.v58.24114
PMCID: PMC4256522  PMID: 25476792
serum cholesterol esters; plasma cholesterol; stearoyl-CoA desaturase-1; saturated fat; n-3 polyunsaturated fatty acids
6.  Ethnic disparities among food sources of energy and nutrients of public health concern and nutrients to limit in adults in the United States: NHANES 2003–2006 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.15784.
Background
Identification of current food sources of energy and nutrients among US non-Hispanic whites (NHW), non-Hispanic blacks (NHB), and Mexican American (MA) adults is needed to help with public health efforts in implementing culturally sensitive and feasible dietary recommendations.
Objective
The objective of this study was to determine the food sources of energy and nutrients to limit [saturated fatty acids (SFA), added sugars, and sodium] and nutrients of public health concern (dietary fiber, vitamin D, calcium, and potassium) by NHW, NHB, and MA adults.
Design
This was a cross-sectional analysis of a nationally representative sample of NWH (n=4,811), NHB (2,062), and MA (n=1,950) adults 19+ years. The 2003–2006 NHANES 24-h recall (Day 1) dietary intake data were analyzed. An updated USDA Dietary Source Nutrient Database was developed using current food composition databases. Food grouping included ingredients from disaggregated mixtures. Mean energy and nutrient intakes from food sources were sample-weighted. Percentages of total dietary intake contributed from food sources were ranked.
Results
Multiple differences in intake among ethnic groups were seen for energy and all nutrients examined. For example, energy intake was higher in MA as compared to NHB; SFA, added sugars, and sodium intakes were higher in NHW than NHB; dietary fiber was highest in MA and lowest in NHB; vitamin D was highest in NHW; calcium was lowest in NHB; and potassium was higher in NHW as compared to NHB. Food sources of these nutrients also varied.
Conclusion
Identification of intake of nutrients to limit and of public health concern can help health professionals implement appropriate dietary recommendations and plan interventions that are ethnically appropriate.
doi:10.3402/fnr.v58.15784
PMCID: PMC4238973  PMID: 25413643
NHANES; energy intake; nutrients to limit; nutrients of public health concern; food sources; diverse ethnicities
7.  Nutritional status in patients with cutaneous leishmaniasis and a study of the effects of zinc supplementation together with antimony treatment 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.23353.
Background
The role of micronutrient status for the incidence and clinical course of cutaneous leishmaniasis is not much studied. Still zinc supplementation in leishmaniasis has shown some effect on the clinical recovery, but the evidence in humans is limited.
Objective
To compare biochemical nutritional status in cutaneous leishmaniasis patients with that in controls and to study the effects of zinc supplementation for 60 days.
Design
Twenty-nine patients with cutaneous leishmaniasis were treated with antimony for 20 days. Fourteen of them got 45 mg zinc daily and 15 of them got placebo. Biomarkers of nutritional and inflammatory status and changes in size and characteristics of skin lesions were measured.
Results
The level of transferrin receptor was higher in patients than in controls but otherwise no differences in nutritional status were found between patients and controls. No significant effects of zinc supplementation on the clinical recovery were observed as assessed by lesion area reduction and characteristics or on biochemical parameters.
Conclusions
It is concluded that nutritional status was essentially unaffected in cutaneous leishmaniasis and that oral zinc supplementation administered together with intramuscular injection of antimony had no additional clinical benefit.
doi:10.3402/fnr.v58.23353
PMCID: PMC4224705  PMID: 25397995
nutritional biomarkers; zinc supplementation; cutaneous leishmaniasis; antimony treatment; clinical chemistry
8.  The effect of immunonutrition (glutamine, alanine) on fracture healing 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.24998.
Background
There have been various studies related to fracture healing. Glutamine is an amino acid with an important role in many cell and organ functions. This study aimed to make a clinical, radiological, and histopathological evaluation of the effects of glutamine on fracture healing.
Methods
Twenty rabbits were randomly allocated into two groups of control and immunonutrition. A fracture of the fibula was made to the right hind leg. All rabbits received standard food and water. From post-operative first day for 30 days, the study group received an additional 2 ml/kg/day 20% L-alanine L-glutamine solution via a gastric catheter, and the control group received 2 ml/kg/day isotonic via gastric catheter. At the end of 30 days, the rabbits were sacrificed and the fractures were examined clinically, radiologically, and histopathologically in respect to the degree of union.
Results
Radiological evaluation of the control group determined a mean score of 2.5 according to the orthopaedists and 2.65 according to the radiologists. In the clinical evaluation, the mean score was 1.875 for the control group and 2.0 for the study group. Histopathological evaluation determined a mean score of 8.5 for the control group and 9.0 for the study group.
Conclusion
One month after orally administered glutamine–alanine, positive effects were observed on fracture healing radiologically, clinically, and histopathologically, although no statistically significant difference was determined.
doi:10.3402/fnr.v58.24998
PMCID: PMC4220003
fracture healing; glutamine; alanine; immunonutrition; antioxidant
9.  Validation of four questions on food habits from the Swedish board of health and social welfare by 3-day food records in medical and nursing students 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.23438.
Background
The Swedish board for health and social welfare (SoS) has presented four questions on dietary habits as indicators of adherence to dietary recommendations. However, these questions have not been evaluated.
Objective
To evaluate if four questions on dietary habits correlate with dietary intake assessed by food records.
Design
A total of 279 medical and nursing students, 170 women and 109 men, completed four questions on usual consumption frequency of vegetables, fruits, fish, and sweets. Depending on scoring from 0 to 12 points, subjects were classified as having low (0–4 points), average (5–8 points), or high (9–12 points) adherence to dietary recommendations as proposed by SoS. Nutrient intake was calculated from 3-day food records. Mean dietary intake, expressed per 10 MJ of fibre, ascorbic acid, folate, vitamin D, sucrose, fish, and fruits and vegetables, was analysed for each group and differences assessed by ANOVA.
Results
Energy intake was 11.8±3.0 MJ in male and 8.5±2.2 MJ in female students. Most students, 64%, were classified as average adherers to dietary recommendations, whereas only 6% were classified as low and 30% as high. Dietary intake of fibre, ascorbic acid, and folate was significantly higher in the high adherence group compared to both the other groups (p<0.01), but vitamin D significantly so only compared to the average group (p=0.002). Intake of fruits and vegetables was significantly different between all groups (p<0.003), with increasing amounts with increasing adherence. The low adherence group had higher intake of sucrose than the other groups (p<0.005). Median fish intake was nil in the low and average adherence groups, with significant difference between high and average adherence groups (p=0.001).
Conclusions
Four questions on the consumption frequency of vegetables, fruits, fish, and sweets correlate well with the dietary intake of fibre, ascorbic acid, folate, vitamin D, fish, sucrose, and fruits and vegetables as assessed by 3-day food records in health-conscious medical and nursing students.
doi:10.3402/fnr.v58.23438
PMCID: PMC4216818
food habits; food questionnaire; food record; nutrition recommendations
10.  Test–retest reliability and validity of a web-based food-frequency questionnaire for adolescents aged 13–14 to be used in the Norwegian Mother and Child Cohort Study (MoBa) 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.23956.
Background
The assessment of food intake is challenging and prone to errors; it is therefore important to consider the reliability and validity of the assessment methods.
Objective
The aim of this study was to analyze the reproducibility and validity of a developed food-frequency questionnaire (FFQ) for use among adolescents.
Design
In total, 58 students (aged 13–14) from four different schools in the southern part of Norway participated in the reproducibility study of filling out the FFQ 4 weeks apart. In addition, 93 students participated in the relative validity study where the FFQ was compared to 2×24-hour dietary recalls, while 92 students participated in the absolute validity study where the intakes of fatty acids and vitamin D from the FFQ were compared to fatty acids and 25-hydroxy-vitamin D3 in whole blood.
Results
The median Spearman correlation coefficient for all nutrients in the test–retest reliability study was 0.57. The median Spearman correlation for all nutrients in the relative validity study was 0.26, while the correlations coefficients were low in the absolute validity study with n-3 fatty acid coefficients ranging from 0.05 to 0.25, and absent for vitamin D (r=0.000).
Conclusion
The test–retest reproducibility was considered good, the relative validity was considered poor to good, and the absolute validity was considered poor. However, the results are comparable to other studies among adolescents.
doi:10.3402/fnr.v58.23956
PMCID: PMC4202197  PMID: 25371661
validation; food-frequency questionnaire; 24-hour dietary recall; adolescents
11.  Prebiotic and synbiotic effects on rats fed malted barley with selected bacteria strains 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.24848.
Background
Butyric acid, one of the key products formed when β-glucans are degraded by the microbiota in the colon, has been proposed to be important for colonic health. Glutamine bound to the fibre may have similar effects once it has been liberated from the fibre in the colon. Both β-glucans and glutamine are found in high amounts in malted barley. Lactobacillus rhamnosus together with malt has been shown to increase the formation of butyric acid further in rats.
Objective
To investigate whether Lactobacillus rhamnosus 271, Lactobacillus paracasei 87002, Lactobacillus plantarum HEAL 9 and 19, and Bifidobacterium infantis CURE 21 affect the levels of short-chain fatty acids and glutamine in caecum and portal blood of rats fed barley malt.
Design
The experimental diets were fed for 12 days. The daily dose of the probiotic strain was 1×109 colony forming units and the intake of fibre 0.82 g/day.
Results
The malt mostly contained insoluble fibre polymers (93%), consisting of glucose and xylose (38–41 g/kg) and some arabinose (21 g/kg). The fibre polysaccharides were quite resistant to fermentation in the rats, regardless of whether or not probiotics were added (25–30% were fermented). Caecal and portal levels of acetic acid decreased in the rats after the addition of L. plantarum HEAL 9 and L. rhamnosus 271, and also the levels of butyric acid. Viable counts of Lactobacillus, Bifidobacterium and Enterobacteriaceae were unaffected, while the caecal composition of Lactobacilli was influenced by the type of strain administrated. Portal levels of glutamine were unchanged, but glycine levels increased with L. plantarum HEAL 9 and 19 and phenylalanine with L. rhamnosus 271.
Conclusions
Although the probiotic strains survived and reached the caecum, except B. infantis CURE 21, there were no effects on viable counts or in the fermentation of different fibre components, but the formation of some bacterial metabolites decreased. This may be due to the high proportion of insoluble fibres in the malt.
doi:10.3402/fnr.v58.24848
PMCID: PMC4189009  PMID: 25317120
dietary fibre; probiotics; short-chain fatty acids; amino acids; microbiota
12.  Salt reduction in vegetable soup does not affect saltiness intensity and liking in the elderly and children 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.24825.
Study background
Reduction of added salt levels in soups is recommended. We evaluated the impact of a 30% reduction of usual added salt in vegetable soups on elderly and children's saltiness and liking evaluation.
Methods
Subjects were elderly and recruited from two public nursing homes (29 older adults, 79.7±8.9 years), and preschool children recruited from a public preschool (49 children, 4.5±1.3 years). This study took place in institutional lunchrooms. Through randomization and crossover, the subjects participated in two sensory evaluation sessions, on consecutive days, to assess perceived saltiness intensity (elderly sample) and liking (elderly and children samples) of a vegetable soup with baseline salt content and with a 30% salt reduction. Elderly rated perceived liking through a 10 cm visual analogue scale [‘like extremely’ (1) to ‘dislike extremely’ (10)] and children through a five-point facial scale [‘dislike very much’ (1) to ‘like very much’ (5)].
Results
After 30% added salt reduction in vegetable soup, there were no significant differences in saltiness noted by the elderly (p=0.150), and in perceived liking by children (p=0.160) and elderly (p=0.860).
Conclusions
A 30% salt reduction in vegetable soup may be achieved without compromising perceived saltiness and liking in children and the elderly.
doi:10.3402/fnr.v58.24825
PMCID: PMC4189011  PMID: 25317121
elderly; preschool children; salt; hedonic evaluation; soup
13.  Postprandial effects on plasma lipids and satiety hormones from intake of liposomes made from fractionated oat oil: two randomized crossover studies 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.24465.
Background
The composition and surface structure of dietary lipids influence their intestinal degradation. Intake of liposomes made of fractionated oat oil (LOO) is suggested to affect the digestion process and postprandial lipemia and also induce satiety.
Objective
In the present study, the metabolic effects on plasma lipids and gut hormones related to satiety were investigated in healthy individuals after intake of LOO, with dairy lipids as placebo.
Design
Two blinded randomized studies with crossover design were performed. In the first study, 19 subjects consumed 35 g lipids from LOO or yoghurt in a breakfast meal. In a follow-up study, 15 women consumed 14 or 1.8 g lipids from LOO mixed in yoghurt. Blood samples were analyzed for plasma lipids, insulin, glucose, and intestinal hormones CCK, PYY, GLP-1, and GLP-2 before and four times after the meal. Subjective analysis of satiety was measured using a visual analog scale questionnaire. Participants recorded their food intake during the rest of the day.
Results
Intake of 35 and 14 g lipids from LOO significantly increased plasma concentrations of CCK, GLP-1, GLP-2, and PYY postprandially. This coincided with a prolonged elevation of triglycerides and large cholesterol-containing particles. Non-esterified fatty acids decreased after intake of 14 and 1.8 g lipids from LOO. The subjective sensation of satiety in women was increased 7 h after intake of 35 g lipids from LOO without any difference in food intake. Our results indicate that intake of 14 g lipids from LOO at breakfast substantially reduced energy intake during the rest of the day.
Conclusions
This study suggests that intake of LOO prolong lipid digestion, affect postprandial plasma lipids and have an effect on satiety. The effect of LOO on GLP-2 indicates that intake of LOO also improve gut health.
doi:10.3402/fnr.v58.24465
PMCID: PMC4189013  PMID: 25317122
polar lipids; liposomes; postprandial lipemia; intestinal hormones; satiety; gut health
14.  Vitamin A status in pregnant women in Iran in 2001 and its relationship with province and gestational age 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.25707.
Background
Vitamin A deficiency is considered as one of the public health problems among pregnant women worldwide. Population representative data on vitamin A status in pregnancy have not previously been published from Iran.
Objectives
The aim of this study was to publish data on vitamin A status in pregnant women in all the provinces of Iran in 2001, including urban and rural areas, and to describe the association of vitamin A status with maternal age, gestational age, and parity.
Design
This descriptive cross-sectional study was conducted on 3,270 healthy pregnant women from the entire country, 2,631 with gestational age ≤36 weeks, and 639 with gestational age >36 weeks. Vitamin A status was determined in serum using high-performance liquid chromatography.
Result
Retinol levels corresponding to deficiency were detected in 6.6% (<0.36 µmol/L) and 18% had insufficient vitamin A levels (≥0.36–<0.7 µmol/L). Suboptimal level of serum retinol was observed in 55.3% of the pregnant women (0.7–1.4 µmol/L). Only about 20% of the women had optimal values (>1.4 µmol/L). The level of serum retinol was lower in older pregnant women (p=0.008), and at higher gestational age (p=0.009). High vitamin A levels were observed in pregnant women in the central areas of Iran and the lowest values in those in the southern areas of Iran.
Conclusions
The vitamin A status was good in 2001 but should be closely monitored also in the future. About 25% of pregnant women had a vitamin A status diagnosed as insufficient or deficient (<0.7 µmol/L). The mean serum retinol decreased as the gestational age increased. The clinical significance of this finding should be further investigated, followed by a careful risk group approach to supplementation during pregnancy.
doi:10.3402/fnr.v58.25707
PMCID: PMC4174306  PMID: 25317119
retinol; insufficiency; deficiency; maternal age; gestational age
15.  Dietary intake and main food sources of vitamin D as a function of age, sex, vitamin D status, body composition, and income in an elderly German cohort 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.23632.
Background
Elderly subjects are at risk of insufficient vitamin D status mainly because of diminished capacity for cutaneous vitamin D synthesis. In cases of insufficient endogenous production, vitamin D status depends on vitamin D intake.
Objective
The purpose of this study is to identify the main food sources of vitamin D in elderly subjects and to analyse whether contributing food sources differ by sex, age, vitamin D status, body mass index (BMI), or household income. In addition, we analysed the factors that influence dietary vitamin D intake in the elderly.
Design and subjects
This is a cross-sectional study in 235 independently living German elderly aged 66–96 years (BMI=27±4 kg/m2). Vitamin D intake was assessed by a 3-day estimated dietary record.
Results
The main sources of dietary vitamin D were fish/fish products followed by eggs, fats/oils, bread/bakery products, and milk/dairy products. Differences in contributing food groups by sex, age, vitamin D status, and BMI were not found. Fish contributed more to vitamin D intake in subjects with a household income of <1,500 €/month compared to subjects with higher income. In multiple regression analysis, fat intake and frequency of fish consumption were positive determinants of dietary vitamin D intake, whereas household income and percentage total body fat negatively affected vitamin D intake. Other parameters, including age, sex, physical activity, smoking, intake of energy, milk, eggs and alcohol, showed no significant association with vitamin D intake.
Conclusion
Low habitual dietary vitamin D intake does not affect vitamin D status in summer, and fish is the major contributor to vitamin D intake independent of sex, age, vitamin D status, BMI, and the income of subjects.
doi:10.3402/fnr.v58.23632
PMCID: PMC4168313  PMID: 25317118
25-hydroxyvitamin D; diet; food sources; fish consumption; body composition
16.  Association of mid-pregnancy antioxidative vitamin and oxidative stress levels with infant growth during the first 3 years of life 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.20207.
Objective
Numerous studies have revealed the impacts of maternal nutritional status on subsequent birth outcome, but much less is known about the long-term impacts on infant growth after birth. We investigated the association between maternal micronutrient levels/oxidative stress status in pregnancy and infant growth during the first 3 years of life.
Design
Prospective cohort study.
Setting
The Ewha Birth & Growth Cohort study was constructed for women who had been recruited between 24 and 28 weeks’ gestation and their offspring at Ewha Womans University Hospital.
Subjects
Maternal serum vitamin and urinary oxidative stress levels were measured, and infant weight, height, and head circumference were measured repeatedly at birth and at 6, 12, 18, 24, and 36 months of age.
Results
Maternal vitamins A and C were positively associated with infant head circumference and infant weight, respectively, during the first 3 years of life, even after controlling for potential confounding factors. But, maternal oxidative stress was not related to infant growth.
Conclusions
The effects of maternal vitamin levels on subsequent infant growth during the first 3 years of life necessitate interventions to supplement antioxidative vitamins during pregnancy.
doi:10.3402/fnr.v58.20207
PMCID: PMC4163581  PMID: 25278823
vitamins; oxidative stress; pregnancy; infant growth; birth outcome; cohort
17.  Bread consumption patterns in a Swedish national dietary survey focusing particularly on whole-grain and rye bread 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.24024.
Background
Bread types with high contents of whole grains and rye are associated with beneficial health effects. Consumer characteristics of different bread consumption patterns are however not well known.
Objective
To compare bread consumption patterns among Swedish adults in relation to selected socio-demographic, geographic, and lifestyle-related factors. For selected consumer groups, the further aim is to investigate the intake of whole grains and the context of bread consumption, that is, where and when it is consumed.
Design
Secondary analysis was performed on bread consumption data from a national dietary survey (n=1,435). Respondents were segmented into consumer groups according to the type and amount of bread consumed. Multiple logistic regressions were performed to study how selected socio-demographic, geographic, and lifestyle-related factors were associated with the consumer groups. Selected consumption groups were compared in terms of whole-grain intake and consumption context. Consumption in different age groups was analysed more in detail.
Results
One-third of the respondents consumed mainly white bread. Socio-demographic, geographic, and healthy-lifestyle-related factors were associated with the bread type consumed. White bread consumption was associated with younger age groups, less education, children in the family, eating less fruit and vegetables, and more candy and snacks; the opposite was seen for mainly whole-grain bread consumers. Older age groups more often reported eating dry crisp bread, whole-grain bread, and whole-grain rye bread with sourdough whereas younger respondents reported eating bread outside the home, something that also mainly white bread eaters did. Low consumers of bread also consumed less whole grain in total.
Conclusions
Traditional bread consumption structures were observed, as was a transition among young consumers who more often consumed fast food bread and bread outside the home, as well as less rye and whole-grain bread. Target groups for communication strategies and product development of more sensorily attractive rye or whole-grain-rich bread should be younger age groups (18–30 years), families with children, and groups with lower educational levels.
doi:10.3402/fnr.v58.24024
PMCID: PMC4157137  PMID: 25278822
public health; whole-grain bread; consumption context
18.  Wheat aleurone polyphenols increase plasma eicosapentaenoic acid in rats 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.24604.
Methods
These studies were designed to assess whether wheat polyphenols (mainly ferulic acid [FA]) increased the very-long-chain omega-3 fatty acids (VLC n-3) [eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)] in rats. Wheat aleurone (WA) was used as a dietary source of wheat polyphenols. Two experiments were performed; in the first one, the rats were fed WA or control pellets (CP) in presence of linseed oil (LO) to provide alpha-linolenic acid (ALA), the precursor of VLC n-3. In the second one, the rats were fed WA or CP in presence of control oil (CO) without ALA. The concentrations of phenolic acid metabolites in urine were also investigated.
Results
The urinary concentration of conjugated FA increased with WA ingestion (p<0.05). Plasma EPA increased by 25% (p<0.05) with WA in the CO group but not in the LO group. In contrast, there was no effect of WA on plasma DHA and omega-6 fatty acids (n-6). Finally, both n-3 and n-6 in the liver remained unchanged by the WA.
Conclusion
These results suggest that WA consumption has a significant effect on EPA in plasma without affecting n-6. Subsequent studies are required to examine whether these effects may explain partly the health benefits associated with whole wheat consumption.
doi:10.3402/fnr.v58.24604
PMCID: PMC4139929  PMID: 25206320
polyphenols; wheat aleurone; very-long-chain omega-3 fatty acids; plasma; liver; rats
19.  Free school fruit: can an extra piece of fruit every school day contribute to the prevention of future weight gain? A cluster randomized trial 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.23194.
Background
Several school fruit programs are initiated with the aim to improve diet and thereby contribute to reduce the prevalence of overweight. To date, no published studies have demonstrated that school fruit schemes do prevent overweight.
Objective
The aim of the present study was to assess if increased consumption of fruits and vegetables, due to free school fruit, have an impact on future weight status.
Design
An intervention study including 10- to 12-year-old children from nine schools in two Norwegian counties (Hedmark and Telemark) participating in the Norwegian School Fruit Program for free during the school year 2001/2002 and children from 29 control schools. Follow-up studies were performed in 2005 and 2009. The cohort includes 1950 pupils (984 boys, 966 girls) at baseline, 1,602 participants in 2005 and 320 participants in the 2009 survey, of which 282 also had participated in 2005.
Results
In 2005, there was no significant difference between the free fruit group and the control group regarding weight status, Body mass index, or perceived weight status. In 2009, a significant difference in prevalence of overweight was observed (15% vs. 25%, p=0.04). In the crude logistic analysis, the OR for being overweight was 0.52 (95% CI: 0.28–0.97) for the intervention group compared to controls. When adjusting for school, sex, grade level and parental education, the association was no longer statistically significant.
Conclusions
These results indicate that free school fruit might contribute to prevent future excessive weight gain. However, the study results are limited by low participation rate.
doi:10.3402/fnr.v58.23194
PMCID: PMC4131001  PMID: 25147495
school fruit scheme; free fruit; fruits and vegetables; overweight; weight status
20.  Calcium and vitamin D supplementation: state of the art for daily practice 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.21796.
Background
Calcium and vitamin D play an essential role in bone metabolism but deficiency and/or inadequate intake are common.
Objectives
To describe a practical approach based on the literature regarding clinically important aspects of calcium and vitamin D supplementation.
Methods
A systematic evaluation of relevant literature in Medline was conducted. We included physiological studies, publications on relevant guidelines, meta-analysis, randomized clinical trials, and cohort studies.
Results
An adequate calcium intake and vitamin D supplementation is recommended in most guidelines xon fracture prevention. Daily supplementation with 800 IU is advocated in most guidelines, appears to be safe, and with this approach it is generally not necessary to determine vitamin D levels. There are no data on additional effects of loading doses of vitamin D on fracture or fall prevention. Calcium supplementation should be tailored to the patient’s need: usually 500 mg per day is required. The intestinal absorption of calcium citrate is approximately 24% better than that of calcium carbonate independent of intake with meals. Data on difference between calcium absorption with calcium carbonate compared to calcium citrate with simultaneous use of proton pump inhibitors are lacking. Concern has arisen about a possible link between calcium supplementation and an increased risk of myocardial infarction. Probably only well-designed prospective randomized controlled trials will be able to allow definite conclusions on this subject.
Conclusion
Daily supplementation with 800 IU vitamin D is a practical and safe strategy without the need for prior determination of vitamin D levels. Calcium supplementation should be tailored to the patient’s need based on total daily dietary calcium intake. In most patients 500 mg per day is required to achieve a total intake of 1,200 mg, or in some 1,000 mg per day. More calcium is absorbed from calcium citrate compared to calcium carbonate.
doi:10.3402/fnr.v58.21796
PMCID: PMC4126954  PMID: 25147494
calcium absorption; vitamin D supplementation; fracture prevention; fall prevention; cardiovascular risk
21.  Socioeconomic differences in selected dietary habits among Norwegian 13–14 year-olds: a cross-sectional study 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.23590.
Background
Social inequalities in health are a major and even growing problem in all European countries.
Objective
The aim of the present study was to describe 1) differences in dietary habits among Norwegian adolescents by gender and socioeconomic status; 2) differences in self-reported knowledge of dietary guidelines among their parents according to socioeconomic status.
Design
In 2012, a cross-sectional study where students filled in a web-based food frequency questionnaire at school was conducted in nine lower secondary schools in Vest-Agder County, Norway. Socioeconomic status (SES) and knowledge of dietary guidelines were obtained from the parents using a web-based questionnaire. In total, 517 ninth-grade students (mean age 13.9) out of 742 invited students participated in the study, giving a participation rate of 69.7%. The total number of dyads with information on both parents and students was 308 (41.5%).
Results
The findings indicate that there is a tendency for girls to have a healthier diet than boys, with greater intake of fruits and vegetables (girls intake in median 3.5 units per day and boys 2.9 units per day), and lower intake of soft drinks (girls 0.25 l in median versus boys 0.5 l per week). Students from families with higher SES reported a significant higher intake of vegetables and fish, and lower intake of soft drinks and fast food than those from lower SES. Parents with higher SES reported a significantly better knowledge of dietary guidelines compared to those with lower SES.
Conclusions
Differences in dietary habits were found between groups of students by gender and SES. Differences were also found in parents’ self-reported knowledge of dietary guidelines. This social patterning should be recognized in public health interventions.
doi:10.3402/fnr.v58.23590
PMCID: PMC4111874  PMID: 25140123
dietary habits; socioeconomic status; nutrition knowledge; adolescents; soft drinks; fruits and vegetables
22.  Effect of the amount and type of dietary fat on cardiometabolic risk factors and risk of developing type 2 diabetes, cardiovascular diseases, and cancer: a systematic review 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.25145.
The effects of both the amount and quality of dietary fat have been studied intensively during the past decades. Previously, low-fat diets were recommended without much attention to the quality of fat, whereas there is general emphasis on the quality of fat in current guidelines. The objective of this systematic review (SR) was to assess the evidence of an effect of the amount and type of dietary fat on body weight (BW), risk factors, and risk of non-communicable diseases, that is, type 2 diabetes (T2DM), cardiovascular diseases (CVD), and cancer in healthy subjects or subjects at risk for these diseases. This work was performed in the process of updating the fourth edition of the Nordic Nutrition Recommendations from 2004. The literature search was performed in October 2010 covering articles published since January 2000. A complementary search was done in February 2012 covering literature until December 2011. Two authors independently selected articles for inclusion from a total of about 16,000 abstracts according to predefined criteria. Randomized controlled trials (RCT) and prospective cohort studies (PCS) were included as well as nested case–control studies. A few retrospective case–control studies were also included when limited or no data were available from other study types. Altogether 607 articles were quality graded and the observed effects in these papers were summarized. Convincing evidence was found that partial replacement of saturated fat (SFA) with polyunsaturated fat (PUFA) or monounsaturated fat (MUFA) lowers fasting serum/plasma total and LDL cholesterol concentrations. The evidence was probable for a decreasing effect of fish oil on concentration of serum/plasma total triglycerides as compared with MUFA. Beneficial effect of MUFA both on insulin sensitivity and fasting plasma/serum insulin concentration was considered as probable in comparisons of MUFA and carbohydrates versus SFA, whereas no effect was found on fasting glucose concentration in these comparisons. There was probable evidence for a moderate direct association between total fat intake and BW. Furthermore, there was convincing evidence that partial replacement of SFA with PUFA decreases the risk of CVD, especially in men. This finding was supported by an association with biomarkers of PUFA intake; the evidence of a beneficial effect of dietary total PUFA, n-6 PUFA, and linoleic acid (LA) on CVD mortality was limited suggestive. Evidence for a direct association between total fat intake and risk of T2DM was inconclusive, whereas there was limited-suggestive evidence from biomarker studies that LA is inversely associated with the risk of T2DM. However, there was limited-suggestive evidence in biomarker studies that odd-chain SFA found in milk fat and fish may be inversely related to T2DM, but these associations have not been supported by controlled studies. The evidence for an association between dietary n-3 PUFA and T2DM was inconclusive. Evidence for effects of fat on major types of cancer was inconclusive regarding both the amount and quality of dietary fat, except for prostate cancer where there was limited-suggestive evidence for an inverse association with intake of ALA and for ovarian cancer for which there was limited-suggestive evidence for a positive association with intake of SFA. This SR reviewed a large number of studies focusing on several different health outcomes. The time period covered by the search may not have allowed obtaining the full picture of the evidence in all areas covered by this SR. However, several SRs and meta-analyses that covered studies published before year 2000 were evaluated, which adds confidence to the results. Many of the investigated questions remain unresolved, mainly because of few studies on certain outcomes, conflicting results from studies, and lack of high quality–controlled studies. There is thus an evident need of highly controlled RCT and PCS with sufficient number of subjects and long enough duration, specifically regarding the effects of the amount and quality of dietary fat on insulin sensitivity, T2DM, low-grade inflammation, and blood pressure. New metabolic and other potential risk markers and utilization of new methodology in the area of lipid metabolism may provide new insight.
doi:10.3402/fnr.v58.25145
PMCID: PMC4095759  PMID: 25045347
body weight; cancer; cardiovascular disease; fat; fatty acid; diet; vegetable oil; stroke; type 2 diabetes
23.  Dietary patterns and changes in body composition in children between 9 and 11 years 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.22769.
Objective
Childhood obesity is rising and dietary intake is a potentially modifiable factor that plays an important role in its development. We aim to investigate the association between dietary patterns, obtained through principal components analysis and gains in fat and lean mass in childhood.
Design
Diet diaries at 10 years of age collected from children taking part in the Avon Longitudinal Study of Parents and Children. Body composition was assessed using dual-energy X-ray absorptiometry at 9 and 11.
Setting
Longitudinal birth cohort.
Subjects
3911 children with complete data.
Results
There was an association between the Health Aware (positive loadings on high-fiber bread, and fruits and vegetables; negative loadings on chips, crisps, processed meat, and soft drinks) pattern score and decreased fat mass gain in girls. After adjusting for confounders, an increase of 1 standard deviation (sd) in this score led to an estimated 1.2% decrease in fat mass gain in valid-reporters and 2.1% in under-reporters. A similar decrease was found only in under-reporting boys. There was also an association between the Packed Lunch (high consumption of white bread, sandwich fillings, and snacks) pattern score and decreased fat mass gain (1.1% per sd) in valid-reporting but not under-reporting girls. The main association with lean mass gain was an increase with Packed Lunch pattern score in valid-reporting boys only.
Conclusions
There is a small association between dietary patterns and change in fat mass in mid-childhood. Differences between under- and valid-reporters emphasize the need to consider valid-reporters separately in such studies.
doi:10.3402/fnr.v58.22769
PMCID: PMC4090365  PMID: 25018688
dietary patterns; principal components analysis; ALSPAC; body composition; valid-reporters
24.  Seafood consumption among pregnant and non-pregnant women of childbearing age in the United States, NHANES 1999–2006 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.23287.
Objectives
Long-chain polyunsaturated fatty acids found in seafood are essential for optimal neurodevelopment of the fetus. However, concerns about mercury contamination of seafood and its potential harm to the developing fetus have created uncertainty about seafood consumption for pregnant women. We compared fish and shellfish consumption patterns, as well as their predictors, among pregnant and non-pregnant women of childbearing age in the US.
Methods
Data from 1,260 pregnant and 5,848 non-pregnant women aged 16–49 years from the 1999 to 2006 National Health and Nutrition Examination Survey (NHANES) were analyzed. Frequency and type of seafood consumed and adjusted associations of multiple characteristics with seafood consumption were estimated for pregnant and non-pregnant women, separately. Time trends were also examined.
Results
There were no significant differences in the prevalence of fish or shellfish consumption, separately or combined, between pregnant and non-pregnant women using either the 30-day questionnaire or the Day 1, 24-h recall. Seafood consumption was associated with higher age, income, and education among pregnant and non-pregnant women, and among fish consumers these groups were more likely to consume ≥3 servings in the past 30 days. Tuna and shrimp were the most frequently reported fish and shellfish, respectively, among both pregnant and non-pregnant women. We observed no significant time trends.
Conclusion
There were no differences in seafood consumption between pregnant and non-pregnant women, and the factors related to seafood consumption were similar for both groups. Our data suggest that many women consume less than the recommended two servings of seafood a week.
doi:10.3402/fnr.v58.23287
PMCID: PMC4056189  PMID: 24959115
pregnant; fish; seafood; NHANES; mercury
25.  Greenhouse gas emissions of realistic dietary choices in Denmark: the carbon footprint and nutritional value of dairy products 
Food & Nutrition Research  2014;58:10.3402/fnr.v58.20687.
Background
Dairy products are important in a healthy diet due to their high nutritional value; they are, however, associated with relatively large greenhouse gas emissions (GHGE) per kg product. When discussing the need to reduce the GHGE caused by the food system, it is crucial to consider the nutritional value of alternative food choices.
Objective
The objective of this study was to elucidate the role of dairy products in overall nutrition and to clarify the effects of dietary choices on GHGE, and to combine nutritional value and GHGE data.
Methods
We created eight dietary scenarios with different quantity of dairy products using data from the Danish National Dietary Survey (1995–2006). Nutrient composition and GHGE data for 71 highly consumed foods were used to estimate GHGE and nutritional status for each dietary scenario. An index was used to estimate nutrient density in relation to nutritional recommendation and climate impact for solid food items; high index values were those with the highest nutrient density scores in relation to the GHGE.
Results
The high-dairy scenario resulted in 27% higher protein, 13% higher vitamin D; 55% higher calcium; 48% higher riboflavin; and 18% higher selenium than the non-dairy scenario. There was a significant correlation between changes in calcium and changes in vitamin D, selenium, and riboflavin content (P=0.0001) throughout all of the diets. The estimated GHGE for the dietary scenario with average-dairy consumption was 4,631 g CO2e/day.
Conclusions
When optimizing a diet with regard to sustainability, it is crucial to account for the nutritional value and not solely focus on impact per kg product. Excluding dairy products from the diet does not necessarily mitigate climate change but in contrast may have nutritional consequences.
doi:10.3402/fnr.v58.20687
PMCID: PMC4053929  PMID: 24959114
sustainable diet; dairy products; nutrient density; nutrient recommendations; greenhouse gas emission

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