Publications by authors named "Ibrahim Elmadfa"

97 Publications

The Effects of Vitamin D Supplementation on Lipid and Inflammatory Profile of Healthy Adolescent Boys: A Randomized Controlled Trial.

Nutrients 2020 Apr 25;12(5). Epub 2020 Apr 25.

Ramin Heshmat, Tehran University of Medical Sciences, Tehran 141675395, Iran.

Background: Deficiency of vitamin D, an anti-inflammatory micronutrient with some favorable effects on lipid profiles, has been found to be highly prevalent in adolescents. We aimed to investigate the effect of a school-based vitamin D supplementation regimen on the correction of vitamin D deficiency as well as lipid and inflammatory profiles of healthy adolescent boys.

Methods: In this randomized single-blind placebo-controlled trial, seventy-one healthy adolescent boys (age 17 years old) were recruited from one high school in Tehran, Iran, and randomly assigned to two groups. The supplement group received vitamin D pearls at a dose of 50,000 IU monthly for 6 months, this dose is indeed defined by the Ministry of Health in Iran for a potential national school-based vitamin D supplementation program. The other group was given placebo pearls for the same duration. Before and after the treatment, the serum levels of 25-hydroxy vitamin D (25(OH) D), parathyroid hormone (PTH), retinol, lead (Pb), the lipid profile and the inflammatory biomarkers were measured and compared.

Results: Between-groups statistical analysis showed that a dose (50,000 IU/month) vitamin D significantly increased the serum levels of 25-hydroxyvitamin D (25 (OH) D) ( < 0.001) and decreased serum levels of PTH ( = 0.003). No significant change was observed in serum levels of retinol and Pb. Between-group analysis revealed that the serum levels of TG (P = 0.001) decreased while an increase in serum levels of HDL ( = 0.021) was observed (< 0.05). Both the within- and between-group analysis showed that serum tumor necrosis factor receptor 2 (TNFR2) concentration declined while serum interleukin-10 (IL-10) increased in response to vitamin D supplementation (< 0.05).

Conclusion: A supplementation regimen of (50,000 IU/month) vitamin D in a context with high rates of vitamin deficiency has shown positive impacts on the serum vitamin D, lipid profile and inflammatory biomarkers in healthy adolescent boys.
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http://dx.doi.org/10.3390/nu12051213DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282007PMC
April 2020

The Association of Vitamin D Status with Lipid Profile and Inflammation Biomarkers in Healthy Adolescents.

Nutrients 2020 Feb 24;12(2). Epub 2020 Feb 24.

Deputy Director of Family Health Department of the Ministry of health and Medical Education, Tehran 1467664961, Iran.

Background: The association between vitamin D status and inflammatory biomarkers and lipid profile is not well known, especially in adolescents. Therefore, the aim of the current study is to investigate the association of vitamin D status with serum lipids and inflammatory biomarkers, including IL-10, IL-6, hsCRP, and TNFR-2, in male adolescents.

Methods And Materials: A sample of seventy-one high school male students, aged 17 years old, from a high school in Tehran were enrolled in the study. They were divided into four groups including group with serum vitamin D below 25 (ng/mL) (SVD < 25; = 36), 25 and above (ng/mL) (SVD ≥ 25; = 35), negative-hsCRP ( = 48), and positive-hsCRP ( = 23). Weight, height, body mass index, dietary intake, serum lipids, and inflammatory biomarkers, including IL-10, IL-6, hsCRP, and TNFR-2, were measured.

Results: In the (SVD < 25) group, the serum level of TNFR-2 was significantly higher compared to that in the (SVD ≥ 25) group. There was a significant negative association between serum TNFR-2 and vitamin D levels in the whole sample. We found significant lower levels of IL-10 in positive-hsCRP group compared to the negative-hsCRP group. In addition, there was a significant negative correlation between the serum vitamin D level and hsCRP in both hsCRP groups. The HDL level was lower in the (SVD < 25) group compared to that in the (SVD ≥ 25) group. Finally, there was a negative correlation between the serum HDL and hsCRP levels in the positive-hsCRP subjects.

Conclusion: Based on the findings it can be concluded that serum vitamin D affects HDL and inflammation status. Although serum levels of HDL and inflammation status are both predictors of metabolic syndrome and cardiovascular disease, further studies are needed to prove it, especially in adolescents.
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http://dx.doi.org/10.3390/nu12020590DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071498PMC
February 2020

Improving Nutrition Information in the Eastern Mediterranean Region: Implementation of Front-Of-Pack Nutrition Labelling.

Nutrients 2020 Jan 26;12(2). Epub 2020 Jan 26.

Freelance Writer and Policy Consultant, 21 Apple Grove, Bognor Regis, West Sussex PO21 4NB, UK.

The provision of simplified nutrition information, in a prominent place on the front of food packages, is recommended as an important element of comprehensive strategies to tackle the burden of death and disease caused by unhealthy diets. There is growing evidence that front-of-pack nutrition labels are preferred by consumers, are more likely to be looked at or noticed than nutrition labelling on the back or side of packages and can help consumers to better identify healthier and less healthy products. This review summarizes current implementation of front-of-pack nutrition labelling policies in the countries of the WHO Eastern Mediterranean Region. Implementation of front-of-pack nutrition labelling in the Eastern Mediterranean Region remains limited, but three types of scheme were identified as having been implemented or at an advanced stage of development by governments in six countries. Through a review of reviews of existing research and evidence from country implementation, the authors suggest some pointers for implementation for other countries in the Region deciding to implement front-of-pack nutrition labelling policies.
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http://dx.doi.org/10.3390/nu12020330DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071186PMC
January 2020

The Association of Potassium Status with Parameters of Glucose Metabolism is influenced by Age in Adults.

Endocr Metab Immune Disord Drug Targets 2020 ;20(5):788-796

Department of Environmental Health, Center for Public Health, Medical University of Vienna, Vienna, Austria.

Background: Potassium status has been found to affect glucose homeostasis.

Objective: This study therefore aimed at investigating relationships between potassium status or dietary intake and fasting plasma glucose (FPG) or glycated haemoglobin (HbA1c) in a sample of Austrian adults (18-80 years, n = 421, 61% women) from the Austrian Study on Nutritional Status 2012.

Methods: Dietary potassium intake was obtained by two 24 h recalls. FPG, plasma K+, and urinary K+ were determined photometrically, HbA1c by HPLC. Associations between the parameters were studied using multiple regression analysis after controlling for confounders and after age stratification of the sample (18-64 y vs. 65-80 y).

Results: Most of the participants had a potassium intake of less than the estimated adequate daily intake of 4000 mg/d. In the multiple regression analyses in the whole sample plasma K+ had a statistically significant positive effect on FPG only in the crude model (ß = 0.128, p < 0.01) and on HbA1c also in the fully adjusted model (ß = 0.129, p < 0.05). The small effects on HbA1c were also detected in the younger age group but were absent in the older population. However, in this latter, a reverse association of urinary K+ on HbA1c was observed as well as of dietary potassium intake on FPG with no effects in the younger sample.

Conclusion: We suggest that age dependent differences in the association between parameters of potassium status and blood glucose regulation should also be taken into account.
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http://dx.doi.org/10.2174/1871530319666191028100109DOI Listing
April 2021

The Role of the Status of Selected Micronutrients in Shaping the Immune Function.

Endocr Metab Immune Disord Drug Targets 2019 ;19(8):1100-1115

Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Vienna, Austria.

Objective: This narrative review gives an overview on the essential role of adequate nutrition to an optimally functioning immune defence. Micronutrients act as regulators of the immune response, with the focus of this review on the immunomodulatory effects of the trace elements iron, zinc and selenium, and the vitamins A, D, E, C, B6 and B12 and folic acid.

Results: Iron deficiency especially impairs the Th1 cell-borne cellular immunity. T lymphocytes are also most affected by a deficiency of zinc, needed for their maturation and the balance between the different T cell subpopulations and acting as a redox signal in the regulation of many enzymes. Selenium is also involved in redox reactions as the glutathione peroxidases and other redox enzymes are selenoproteins. Selenium status has shown special effects on cellular immunity and resistance to viral infections. Vitamin A in the form of retinoic acid induces a humoral Th2 cell response via antigen-presenting cells and is involved in maintaining intestinal immune defence and tolerance through its nuclear receptor RAR and via kinase signalling cascades. Immune tolerance is particularly promoted by vitamin D acting through dendritic cells to stimulate the differentiation of regulatory T cells. Vitamin E has antiinflammatory effects and stimulates naïve T cells especially in the elderly. Besides its antioxidative properties, vitamin C has effects on cell signalling and epigenetic regulation. The B vitamins are required for cytotoxic cellular immunity and modulate T cell responses.

Conclusion: A diverse diet and regular exposure to sunlight are the best sources for a balanced nutrient supply to maintain an optimal immune defence.
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http://dx.doi.org/10.2174/1871530319666190529101816DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7360912PMC
April 2020

Revised Reference Values for the Intake of Protein.

Ann Nutr Metab 2019 22;74(3):242-250. Epub 2019 Mar 22.

Department of Nutrition and Food Sciences, University of Bonn, Bonn, Germany.

Background: Following a timely update process, the nutrition societies of Germany, Austria, and Switzerland (D-A-CH) revised the reference values for the intake of protein in 2017. The Working Group conducted a structured literature search in PubMed considering newly published papers (2000- 2017).

Summary: For infants < 4 months, the estimated values were set based on the protein intake via breast milk. Reference values for infants > 4 months, children, adolescents, pregnant, and lactating women were calculated using the factorial method considering both requirement for growth and maintenance. For adults, reference values were derived from nitrogen balance studies; for seniors (> 65 years), reports on metabolic and functional parameters under various protein intakes were additionally considered. Reference -values (g protein/kg body weight per day) were set as follows: infants  < 4 months: 2.5-1.4, children: 1.3-0.8, adults < 65 years: 0.8, adults > 65 years: 1.0. Key Messages: The reference values for infants, children, adolescents, and adults < 65 years are essentially unchanged compared to recently published values. Scientifically reliable data published between 2000 and 2017 guided the D-A-CH Working Group to set a higher estimated value for adults > 65 years. Since the energy consumption continuously decreases with age, this new estimated protein intake value might be a challenge for the introduction of food-based nutrition concepts for older people.
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http://dx.doi.org/10.1159/000499374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6492513PMC
April 2020

Zinc intake and status in Austria in the light of different reference values.

Int J Vitam Nutr Res 2017 May 1;87(3-4):169-178. Epub 2019 Feb 1.

1 Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Vienna, Austria.

Zinc has been identified as a critical micronutrient also in high-income countries. There is still some uncertainty about the evaluation of zinc sufficiency due to divergent daily intake reference values. We wanted to exemplify this issue using data from the Austrian Study on Nutritional Status 2012. Plasma zinc concentrations were measured in a nationally representative sample of 872 persons aged 6-80 years (55.5 % female). Dietary zinc intake was estimated from two 24h dietary recalls. Additionally, parameters of the antioxidative status (plasma malondialdehyde (MDA), total antioxidative capacity) and activities of alkaline phosphatase (AP), superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px)) were determined. Zinc status was marginal in schoolchildren (40 % of boys and 22 % of girls) and in elderly (28 % of men and 33 % of women). Dietary zinc intake was also unsatisfactory in these groups with 38 % of boys and 32 % of girls and 64.5 % of older men below the nationally recommended intake levels. However, the adequacy of zinc intake varied with different reference values. Adults were more likely to meet the D-A-CH reference values and those from the European Food Safety Authority than the recommendations of the International Zinc Nutrition Consultative Group (IZiNCG) and the Institute of Medicine, whereas children met the IZiNCG values best. Zinc status correlated weakly with AP activity (r = -0.298, p < 0.001) and some antioxidant status markers (CAT, MDA, GSH-PX, SOD), especially in the elderly (MDA: r = -0.527, p < 0.001, and SOD: r = -0.466, p = 0.002). Our results suggest a suboptimal zinc supply in Austria particularly among schoolchildren and older adults.
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http://dx.doi.org/10.1024/0300-9831/a000484DOI Listing
May 2017

Rationale and Plan for Vitamin D Food Fortification: A Review and Guidance Paper.

Front Endocrinol (Lausanne) 2018 17;9:373. Epub 2018 Jul 17.

Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium.

Vitamin D deficiency can lead to musculoskeletal diseases such as rickets and osteomalacia, but vitamin D supplementation may also prevent extraskeletal diseases such as respiratory tract infections, asthma exacerbations, pregnancy complications and premature deaths. Vitamin D has a unique metabolism as it is mainly obtained through synthesis in the skin under the influence of sunlight (i.e., ultraviolet-B radiation) whereas intake by nutrition traditionally plays a relatively minor role. Dietary guidelines for vitamin D are based on a consensus that serum 25-hydroxyvitamin D (25[OH]D) concentrations are used to assess vitamin D status, with the recommended target concentrations ranging from ≥25 to ≥50 nmol/L (≥10-≥20 ng/mL), corresponding to a daily vitamin D intake of 10 to 20 μg (400-800 international units). Most populations fail to meet these recommended dietary vitamin D requirements. In Europe, 25(OH)D concentrations <30 nmol/L (12 ng/mL) and <50 nmol/L (20 ng/mL) are present in 13.0 and 40.4% of the general population, respectively. This substantial gap between officially recommended dietary reference intakes for vitamin D and the high prevalence of vitamin D deficiency in the general population requires action from health authorities. Promotion of a healthier lifestyle with more outdoor activities and optimal nutrition are definitely warranted but will not erase vitamin D deficiency and must, in the case of sunlight exposure, be well balanced with regard to potential adverse effects such as skin cancer. Intake of vitamin D supplements is limited by relatively poor adherence (in particular in individuals with low-socioeconomic status) and potential for overdosing. Systematic vitamin D food fortification is, however, an effective approach to improve vitamin D status in the general population, and this has already been introduced by countries such as the US, Canada, India, and Finland. Recent advances in our knowledge on the safety of vitamin D treatment, the dose-response relationship of vitamin D intake and 25(OH)D levels, as well as data on the effectiveness of vitamin D fortification in countries such as Finland provide a solid basis to introduce and modify vitamin D food fortification in order to improve public health with this likewise cost-effective approach.
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http://dx.doi.org/10.3389/fendo.2018.00373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6056629PMC
July 2018

Effects of an enhanced iron dense foods offering in the daily meals served in geriatric institutions on measures of iron deficiency anemia.

BMC Geriatr 2018 05 25;18(1):123. Epub 2018 May 25.

Haus der Barmherzigkeit, Long term care hospital, Seeböckgasse 30a, 1060, Vienna, Austria.

Background: Iron deficiency is one of the most common causes of anemia in geriatric patients. Although the oral iron intake is often inadequate, the potential of iron dense foods in the daily meals of geriatric institutions is rarely considered. To test during a 1- year span whether an improved frequency of iron dense foods in the daily meals has an impact on the oral iron intake, the hemoglobin concentration and anemia prevalence of institutionalized geriatric patients. A parallel, open, pre-and post-oral nutrition intervention study. Two geriatric hospitals participated as intervention centers and one as comparison center.

Methods: In the two intervention centers, a menu plan adapted with iron dense foods was applied. In the comparison center the regular meals provisions was continued. At months 1, 6 and 12 of the intervention time the routine blood-parameter hemoglobin was taken from the geriatric hospital's medical report. Component analysis assessed the nutrient density of the offered meals. 2-day-weighing records realized at month 1 and 6 of intervention-time assessed the iron intake. Ninety-nine geriatric patients in the intervention centers and 37 in the comparison center. All of them had multiple chronic diseases and an average age of 84 years. With the non-parametric Friedmann-Test for repeated measurements, we establish differences within the groups. With the Mann-Whitney-U-Test, we establish differences between the groups. For dichotomous variables, the chi-square-test was used. A p-value of< 0.05 was considered statistically significant for all analyses.

Results: In the intervention centers the iron intake (p < 0.001) and the hemoglobin concentration (p = 0.002) improved significantly (p < 0.001). As in the comparison center the frequency of meat and sausage offerings was twice as much as recommended also the hemoglobin concentration improved (p = 0.001).

Conclusion: Geriatric patients with anemia or low hemoglobin level benefit optimally from a diet rich in iron dense foods. Enhanced access to such can indeed correct iron deficiency anemia.

Trial Registration: The ethics committee of the Municipality of Vienna ( EK-13-043-0513 ) approved the study.
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http://dx.doi.org/10.1186/s12877-018-0800-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5970462PMC
May 2018

A global database of food and nutrient consumption.

Bull World Health Organ 2016 Dec 16;94(12):931-934. Epub 2016 Sep 16.

Tufts Friedman School of Nutrition Science & Policy, 150 Harrison Avenue, Boston, MA 02111, USA .

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http://dx.doi.org/10.2471/BLT.15.156323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153920PMC
December 2016

Animal Proteins as Important Contributors to a Healthy Human Diet.

Annu Rev Anim Biosci 2017 02 28;5:111-131. Epub 2016 Oct 28.

Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Vienna 1010, Austria; email: ,

Adequate protein intake is critical for health and development. Generally, protein of animal origin is of higher quality for humans owing to its amino acid pattern and good digestibility. When administered in mixtures it can enhance the quality of plant proteins, but its availability is often low in low-income communities, especially in young children, the elderly, and pregnant and lactating women, who have increased requirements and in whom high-quality protein also stimulates (bone) growth and maintenance. Although high protein intake was associated with increased type 2 diabetes mellitus risk, milk and seafood are good sources of branched chain amino acids and taurine, which act beneficially on glucose metabolism and blood pressure. However, high consumption of protein-rich animal food is also associated with adverse health effects and higher risk for noncommunicable diseases, partly related to other components of these foods, like saturated fatty acids and potential carcinogens in processed meat but also the atherogenic methionine metabolite homocysteine. In moderation, however, animal proteins are especially important for health maintenance in vulnerable persons.
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http://dx.doi.org/10.1146/annurev-animal-022516-022943DOI Listing
February 2017

Effect of saliva on physical food properties in fat texture perception.

Crit Rev Food Sci Nutr 2017 Apr;57(6):1061-1077

d Department of Food Science and Technology , University of Ljubljana , Ljubljana , Slovenia.

Sensory properties of food drive our food choices and it is generally accepted that lipids greatly contribute to the sensory properties of many foods and consequently to eating pleasure. Many studies have investigated the mechanisms of the fat perception. Unfortunately they used a variety of methods and products, thereby making generalization very difficult. The mechanism of fat perception in oral cavity is combined of several processes. Lipid composition and its properties strongly influence food structure. During consumption food is exposed to a range of in-mouth processing steps. Oral sensation of fat texture changes with time, from a first bite to chewing, while mixing with saliva, up to swallowing and even after swallowing. The present work reviews many aspects of fat texture perception from physical chemistry to physiology. Understanding the underlying mechanisms of in-mouth lipid processing would provide new concepts to produce low-fat food products with full-fat perception.
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http://dx.doi.org/10.1080/10408398.2013.766787DOI Listing
April 2017

The energy intake through regular nontherapeutic meals provision in long-term care: impact on nutritional status and related Geriatric Nutritional Risk Index.

Springerplus 2016 20;5:136. Epub 2016 Feb 20.

"Haus der Barmherzigkeit", Long Term Care Hospital, Seeböckgasse 30a, 1160 Vienna, Austria.

To investigate how the energy intake of institutionalized long-term-care patients through the regular nontherapeutic meals provision is associated with the nutritional status and the Geriatric Nutritional Risk Index (GNRI). A 9 month longitudinal, observational study. Long-term-care Hospital. 66 long-term-care patients with multiple medical conditions and solely oral food-intake. 47 (71 %) patients, predominantly women (n = 39/47), with a mean age of 83.04 (±9.58) years completed study time and 19 (29 %) deceased. At week 1 and week 36 of observation time energy intake was measured by means of three-days-weighing-records. Body composition was assessed with bioelectrical impedance analysis. Serum albumin, body weight and body height were taken from the medical report. Albumin content, body weight and height were used to calculate the Geriatric Nutritional Risk Index: GNRI = [1.489 × albumin (g/L)] + [41.7 × (weight/ideal body weight)]. Energy intake was significantly below 24 kcal/kg body weight per day. The GNRI of the deceased patients was significantly (p = 0.002) lower than the GNRI of the completers. During observation time energy-intake p < 0.001, body fat (p = 0.001) and phase angle (PA) of bio impedance measurement (p = 0.018) and likewise the GNRI (p = 0.021) of the completers decreased significantly. At the beginning and at the end of observation time energy intake correlated significantly with PA (p = 0.028/p < 0.001) and GNRI (p = 0.436/p = 0.004). Also GNRI and PA correlated significantly at the beginning (p = 0.001) and at the end (p < 0.001) of observation time. The energy intake through non therapeutic meals provision was too low for sustaining the nutritional status and likewise the GNRI. The malnourishment and the nutrition related clinical risk of the geriatric patients aggrevated during observation time.
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http://dx.doi.org/10.1186/s40064-016-1763-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761357PMC
March 2016

The role of dietary potassium in hypertension and diabetes.

J Physiol Biochem 2016 Mar 3;72(1):93-106. Epub 2015 Dec 3.

Institute of Physiology, Center for Physiology and Pharmacology, Medical University of Vienna, Schwarzspanierstrasse 17, 1090, Vienna, Austria.

Potassium is an essential mineral which plays major roles for the resting membrane potential and the intracellular osmolarity. In addition, for several years, it has been known that potassium also affects endothelial and vascular smooth muscle functions and it has been repeatedly shown that an increase in potassium intake shifts blood pressure to a more preferable level. Meanwhile, the blood pressure lowering effects of potassium were presented in several intervention trials and summarized in a handful of meta-analyses. Furthermore, accumulating epidemiological evidence from, especially, the last decade relates low dietary potassium intake or serum potassium levels to an increased risk for insulin resistance or diabetes. However, intervention trials are required to confirm this association. So, in addition to reduction of sodium intake, increasing dietary potassium intake may positively affect blood pressure and possibly also glucose metabolism in many populations. This concise review not only summarizes the studies linking potassium to blood pressure and diabetes but also discusses potential mechanisms involved, like vascular smooth muscle relaxation and endothelium-dependent vasodilation or stimulation of insulin secretion in pancreatic β-cells, respectively.
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http://dx.doi.org/10.1007/s13105-015-0449-1DOI Listing
March 2016

Patterns of drinking and eating across the European Union: implications for hydration status.

Nutr Rev 2015 Sep;73 Suppl 2:141-7

I. Elmadfa and A.L. Meyer are with the Institute for Nutritional Sciences, University of Vienna, Vienna, Austria.

Appropriate hydration is essential for health and well-being. In Europe, water consumption patterns vary despite the unlimited availability of this resource. Water constitutes the largest proportion of total fluid intake in most countries. According to the 2008 European Food Safety Authority's Concise Food Consumption Database, tap water consumption was highest in the northern European countries and in Austria. While Germany had a particularly low intake of tap water, it led in consumption of fruit and vegetable juices, soft drinks, and especially bottled water. European nutrition surveys generally report an average fluid intake within the recommended range of 1500-2000 mL/day, with higher intake levels corresponding with increasing frequency of intake. However, some population groups consume less than others, e.g., the elderly who are at higher risk for dehydration due to age-related increased urinary fluid losses. In turn, physical activity is associated with higher beverage consumption as is adherence to a health-conscious diet. While water constitutes the most commonly consumed beverage throughout Europe, drinking patterns and quantities vary and are influenced by a variety of factors, including age, gender, diet, and physical activity level.
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http://dx.doi.org/10.1093/nutrit/nuv034DOI Listing
September 2015

Eating out is different from eating at home among individuals who occasionally eat out. A cross-sectional study among middle-aged adults from eleven European countries.

Br J Nutr 2015 Jun 24;113(12):1951-64. Epub 2015 Apr 24.

WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens,75 Mikras Asias Street,Goudi, Athens11527,Greece.

Eating out has been linked to the current obesity epidemic, but the evaluation of the extent to which out of home (OH) dietary intakes are different from those at home (AH) is limited. Data collected among 8849 men and 14,277 women aged 35-64 years from the general population of eleven European countries through 24-h dietary recalls or food diaries were analysed to: (1) compare food consumption OH to those AH; (2) describe the characteristics of substantial OH eaters, defined as those who consumed 25 % or more of their total daily energy intake at OH locations. Logistic regression models were fit to identify personal characteristics associated with eating out. In both sexes, beverages, sugar, desserts, sweet and savoury bakery products were consumed more OH than AH. In some countries, men reported higher intakes of fish OH than AH. Overall, substantial OH eating was more common among men, the younger and the more educated participants, but was weakly associated with total energy intake. The substantial OH eaters reported similar dietary intakes OH and AH. Individuals who were not identified as substantial OH eaters reported consuming proportionally higher quantities of sweet and savoury bakery products, soft drinks, juices and other non-alcoholic beverages OH than AH. The OH intakes were different from the AH ones, only among individuals who reported a relatively small contribution of OH eating to their daily intakes and this may partly explain the inconsistent findings relating eating out to the current obesity epidemic.
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http://dx.doi.org/10.1017/S0007114515000963DOI Listing
June 2015

Developing suitable methods of nutritional status assessment: a continuous challenge.

Adv Nutr 2014 Sep;5(5):590S-598S

Reliable information about the nutritional status is essential to identify potential critical nutrients and the population groups at risk of deficiency, as well as to develop effective public health policies to counteract unfavorable nutrition patterns that contribute to morbidity and mortality. In this review, the important role of biomarkers in the assessment of nutritional status is outlined, major strengths and limitations of established and new biomarkers are described, and important criteria for biomarker selection and development are discussed. Indeed, biomarkers offer a more objective assessment tool than pure dietary approaches that suffer from inadequate data reporting in particular, although biomarkers are often only measured in subsamples because of the higher costs and proband burden they entail. However, biomarkers are subject to individual variability and influences from other factors besides the nutrient of interest. Rapid turnover or tight control of nutrient concentrations in blood (homeostasis) limits their sensitivity as biomarkers, as in the case of many trace elements. The existence of different forms of a micronutrient in the body adds additional complexity. Functional biomarkers, such as enzyme activities, mirror long-term status better but are subject to confounding factors, and some are influenced by several micronutrients, not specific for only 1, so using a combination of biomarkers is advisable. Additionally, the applicability of a biomarker also depends on the existence of adequate reference values and cutoff points for the target population. Therefore, a careful selection is warranted, especially when biomarkers are to be used in larger samples.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4188242PMC
http://dx.doi.org/10.3945/an.113.005330DOI Listing
September 2014

Phytosterol content and fatty acid pattern of ten different nut types.

Int J Vitam Nutr Res 2013 ;83(5):263-70

Institute of Nutritional Sciences, University of Vienna, Austria.

Ten different nut kinds (almonds, Brazil nuts, cashews, hazelnuts, macadamias, peanuts, pecans, pine nuts, pistachios, and walnuts) were evaluated for their total oil and phytosterol content as well as their fatty acid composition. The total oil content was the predominant component; mean values oscillated between 45.2 % (cashews) and 74.7 % (macadamias). Mean total phytosterol content ranged from 71.7 mg (Brazil nuts) to 271.9 mg (pistachios) per 100 g oil. ß-sitosterol was the major sterol (mean >71.7 mg/100 g oil) followed by minor contents of campesterol, ergosterol, and stigmasterol. Almonds, cashews, hazelnuts, macadamias, and pistachios were high in monounsaturated fatty acids (MUFA; > 55 %). MUFA- and polyunsaturated fatty acid (PUFA)-rich nuts were peanuts and pecans, whereas Brazil nuts, pine nuts, and walnuts had the highest PUFA content (> 50 %); the high unsaturated/saturated fatty acid ratio ranged from 4.5 to 11.8. However, the fatty acid pattern of every nut is unique.
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http://dx.doi.org/10.1024/0300-9831/a000168DOI Listing
January 2015

Iron-fortified flour: can it induce lipid peroxidation?

Int J Food Sci Nutr 2014 Aug 24;65(5):649-54. Epub 2014 Mar 24.

Department of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences , Tehran , Islamic Republic of Iran .

This community-based study was conducted to evaluate the effects of iron-fortified bread consumption on certain biomarkers of oxidative stress in an apparently healthy population. Evaluation of food intake, anthropometric and laboratory variables was performed in the beginning and after the 8-month intervention for all participants. There was no significant change in oxidative stress biomarkers in women following 8 months intervention. However, in men, final values of total antioxidant capacity, compared to the initial ones, showed a significant decrease in (p = 0.01) which was accompanied by a significant increase in superoxide dismutase (p = 0.002). It could be concluded that although the short-term period (8 months) of extra iron intake did not show severe effects of lipid per oxidation, significant changes of serum iron and some oxidative stress indices suggested that fortification of flour with iron among non-anemic adults in the long term was not without adverse effects.
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http://dx.doi.org/10.3109/09637486.2014.898254DOI Listing
August 2014

Health significance of fat quality in the diet.

Ann Nutr Metab 2013 14;63(1-2):96-102. Epub 2013 Aug 14.

ScienceVoice Consulting, Denver, Colo., USA.

This paper summarizes three presentations on the global and Latin American perspectives on the health significance of fat quality in the diet given at the 16th Congress of the Society of Latin American Nutrition in Havana, Cuba, November 11-16, 2012. Dietary fat quality contributes to the risk of the leading chronic diseases and is more important than fat quantity in reducing the risk of chronic disease mortality, especially from cardiovascular disease (CVD). In many countries, the consumption of saturated fats exceeds the recommended limit of 10% energy (%E) and intakes of polyunsaturated fats (PUFAs) are often below the recommended range of 6-11%E. Consumption of long-chain ω-3 PUFAs is especially low. In many Latin American countries, high consumption of carbohydrates, especially sugars, contributes to obesity, diabetes, hypertension and CVD, while intakes of total fat and PUFAs may be low. Thus, dietary fat recommendations must consider the dietary fat patterns of each country. Nutrition counseling can be effective in teaching individuals and families to modify their food intake patterns and control the major risk factors for chronic disease.
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http://dx.doi.org/10.1159/000353207DOI Listing
April 2014

Vitamins for the first 1000 days: preparing for life.

Int J Vitam Nutr Res 2012 Oct;82(5):342-7

Department of Nutritional Sciences, University of Vienna, Austria.

Vitamins are essential nutrients for many body functions and particularly important during growth. Adequate supply in pregnancy and in early infancy is therefore crucial, but there is still a lack of knowledge about the needed amounts of vitamins of children older than six months and also during pregnancy. Recommendations for intake levels are generally derived by extrapolation from data for infants based in turn on the contents in breast milk and those for adults. A vitamin of particular importance in pregnancy is folic acid due to its role in the development of the brain and nerve system and the prevention of fetal neural tube defects (NTD). Mandatory fortification of flour and certain other grain products in many countries has been associated with a reduction in NTD incidence. However, other deficiencies or suboptimal status of B vitamins, especially B6 and B12 have been repeatedly reported in pregnant women also in high-income countries. Vitamin A is one of the three most critical micronutrients globally and pregnant women and young children are especially vulnerable to deficiencies. Night blindness, anemia, and immunodeficiency are major consequences of inadequate supply in these populations. Much attention has recently been accorded vitamin D that is also critical in pregnant women and young children for instance because of its involvement in bone mineralization but also its more recently discovered immune-modulating function that is thought to prevent development of autoimmune diseases like diabetes mellitus type I. A healthy balanced diet provides the best basis for optimal pregnancy outcome, lactation performance, and complementary feeding. However, supplements or fortified foods may be needed to cover the high requirements especially of critical vitamins such as vitamin D and folic acid and to correct unfavorable dietary patterns in women or to adapt foods to the needs of young children.
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http://dx.doi.org/10.1024/0300-9831/a000129DOI Listing
October 2012

Nutritional supplements and plasma antioxidants in childhood asthma.

Wien Klin Wochenschr 2013 Jun 1;125(11-12):309-15. Epub 2013 May 1.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.

Objective: This study investigated the relationship of plasma antioxidants to airway inflammation and systemic oxidative stress in children suffering from atopic asthma with consideration of the intake of nutritional supplements.

Subjects And Research Methods: A total of 35 asthmatic children (AG) and 21 healthy controls (CG) participated in this study. Plasma levels of vitamins A and E, β-carotene, coenzyme Q10 and malondialdehyde (MDA) were analyzed with high-performance liquid chromatography (HPLC); the total antioxidant capacity (TAC) was measured photometrically, and selenium was determined by atomic absorption spectroscopy (AAS). The volume of fractionated exhaled nitric oxide (FeNO) was measured with the NIOX nitric oxide monitoring system.

Results: The plasma antioxidants vitamins A and E, selenium, and coenzyme Q10 but not β-carotene were significantly (p < 0.05) lower in asthmatics than in controls. Further, asthmatic children had significantly reduced plasma concentrations of TAC (p < 0.01), significantly enhanced levels of MDA (p < 0.001), and exhaled a significantly (p < 0.001) higher mean volume of FENO than healthy children. Regular intake of supplements had a significant positive influence on plasma vitamin E (p < 0.01), selenium (p < 0.01), TAC (p < 0.05), MDA (p < 0.01), and FENO (p < 0.01) in asthmatics but not in controls. Additionally, significant negative associations of vitamin E and MDA (AG: p < 0.01; CG: p < 0.05), and vitamin E and FENO (AG: p < 0.05; CG: p > 0.05) were identified.

Conclusion: These results indicate that nutritional supplements beneficially modulate plasma antioxidants and thus might have a positive influence on systemic redox balance and subsequently, pulmonary inflammation in asthmatic children.
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http://dx.doi.org/10.1007/s00508-013-0359-6DOI Listing
June 2013

Behaviour change for better health: nutrition, hygiene and sustainability.

BMC Public Health 2013 21;13 Suppl 1:S1. Epub 2013 Mar 21.

Unilever Research and Development, Olivier van Noortlaan 120, 3133 AT Vlaardingen, the Netherlands.

As the global population grows there is a clear challenge to address the needs of consumers, without depleting natural resources and whilst helping to improve nutrition and hygiene to reduce the growth of noncommunicable diseases. For fast-moving consumer goods companies, like Unilever, this challenge provides a clear opportunity to reshape its business to a model that decouples growth from a negative impact on natural resources and health. However, this change in the business model also requires a change in consumer behaviour. In acknowledgement of this challenge Unilever organised a symposium entitled 'Behaviour Change for Better Health: Nutrition, Hygiene and Sustainability'. The intention was to discuss how consumers can be motivated to live a more healthy and sustainable lifestlye in today's environment. This article summarises the main conclusions of the presentations given at the symposium. Three main topics were discussed. In the first session, key experts discussed how demographic changes - particularly in developing and emerging countries - imply the need for consumer behaviour change. The second session focused on the use of behaviour change theory to design, implement and evaluate interventions, and the potential role of (new or reformulated) products as agents of change. In the final session, key issues were discussed regarding the use of collaborations to increase the impact and reach, and to decrease the costs, of interventions. The symposium highlighted a number of key scientific challenges for Unilever and other parties that have set nutrition, hygiene and sustainability as key priorities. The key challenges include: adapting behaviour change approaches to cultures in developing and emerging economies; designing evidence-based behaviour change interventions, in which products can play a key role as agents of change; and scaling up behaviour change activities in cost-effective ways, which requires a new mindset involving public-private partnerships.
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http://dx.doi.org/10.1186/1471-2458-13-S1-S1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3605264PMC
May 2013

The origins of a global standard for food quality and safety: Codex Alimentarius Austriacus and FAO/WHO Codex Alimentarius.

Int J Vitam Nutr Res 2012 Jun;82(3):223-7

Bureau of the Codex Commission, Ministry of Health, Vienna, Austria.

In the second half of the 19(th) century the incidence of food adulterations increased very rapidly, prompting many European countries to put into force food laws to fight these practices. A number of parallel attempts were undertaken to establish a collection of instructions for the assessment of food samples to warrant the comparability of results obtained and interpreted by different experts. The first official steps towards such a standardization was made in 1891 at an international meeting of food chemists and microscopic scientists in Vienna. As a consequence, Austria installed a “Scientific Commission” in 1891, which drafted chapters for a future Codex Alimentarius Austriacus. In 1907, a Codex Commission was installed by the Ministry of Interior, but it took about four years, from 1907 to 1911, before the first edition of this compendium was published. So far, four editions have followed. The Codex Alimentarius Austriacus is a set of standards and guidelines for stakeholders, authorities, and law courts as a base for their activities. It has evolved over the past 100 years to become a flexible instrument, which has become indispensable for Austria. After 1945, attempts were made in different parts of the world to develop standardized rules for the testing of food samples to prevent trade barriers within the respective region. In Europe for instance, the development of a Codex Alimentarius Europaeus initiated by the Austrian Hans Frenzel, and based upon the model of the Codex Alimentarius Austriacus, made good progress. A number of other European countries were involved in this project. However, the Food and Agriculture Organization (FAO) and the World Health Organization (WHO) of the United Nations were intent on impeding such regional activities to prevent trade barriers at a global level. Between 1960 and 1963, steps were taken to install a FAO/WHO Codex partly in close cooperation with the Codex Alimentarius Europaeus. Since 1963, the FAO/WHO Codex Commission has issued the FAO/WHO Codex Alimentarius, which took its name and some organizational aspects from Codex Alimentarius Europaeus, that was itself modeled after the Codex Alimentarius Austriacus. The Codex Alimentarius Europaeus was incorporated into the Codex Alimentarius Commission as the regional coordinating committee for Europe, thus providing a model for the six regional coordination committees of the Codex Alimentarius Commission existing today.
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http://dx.doi.org/10.1024/0300-9831/a000115DOI Listing
June 2012

Food safety security: a new concept for enhancing food safety measures.

Int J Vitam Nutr Res 2012 Jun;82(3):216-22

Biomineral Sciences International, Bethesda MD, USA.

The food safety security (FSS) concept is perceived as an early warning system for minimizing food safety (FS) breaches, and it functions in conjunction with existing FS measures. Essentially, the function of FS and FSS measures can be visualized in two parts: (i) the FS preventive measures as actions taken at the stem level, and (ii) the FSS interventions as actions taken at the root level, to enhance the impact of the implemented safety steps. In practice, along with FS, FSS also draws its support from (i) legislative directives and regulatory measures for enforcing verifiable, timely, and effective compliance; (ii) measurement systems in place for sustained quality assurance; and (iii) shared responsibility to ensure cohesion among all the stakeholders namely, policy makers, regulators, food producers, processors and distributors, and consumers. However, the functional framework of FSS differs from that of FS by way of: (i) retooling the vulnerable segments of the preventive features of existing FS measures; (ii) fine-tuning response systems to efficiently preempt the FS breaches; (iii) building a long-term nutrient and toxicant surveillance network based on validated measurement systems functioning in real time; (iv) focusing on crisp, clear, and correct communication that resonates among all the stakeholders; and (v) developing inter-disciplinary human resources to meet ever-increasing FS challenges. Important determinants of FSS include: (i) strengthening international dialogue for refining regulatory reforms and addressing emerging risks; (ii) developing innovative and strategic action points for intervention {in addition to Hazard Analysis and Critical Control Points (HACCP) procedures]; and (iii) introducing additional science-based tools such as metrology-based measurement systems.
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http://dx.doi.org/10.1024/0300-9831/a000114DOI Listing
June 2012

Chemical and biological modulations of food due to the frying process.

Int J Vitam Nutr Res 2012 Jun;82(3):163-7

Department of Nutritional Sciences, University of Vienna, AT-1090 Vienna, Austria.

The interactions between frying fat and fried foods are of great relevance for the nutritional quality of the final product. In particular, the amount of fat taken up can be positively influenced at the industrial but also at the household level by different pre- and post-frying conditions. The fat uptake during the frying process can also lead to a complete different fatty acid pattern of the product. The change is always towards the predominant fatty acids in the frying fat, which can be beneficial when replacing saturated fatty acids with monounsaturated fatty acids and polyunsaturated fatty acids, but can also be of disadvantage in the case of fish, when the initial content of n-3 fatty acids is significantly reduced. This has also to be considered for nutritional calculation so as not to misrepresent the nutrient composition of the fried product. There have been positive developments in producing frying fats which are low in trans-fatty acids, and fried products low in heat-induced compounds which can address toxicological concerns such as acrylamide formation.
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http://dx.doi.org/10.1024/0300-9831/a000107DOI Listing
June 2012

Diet quality, a term subject to change over time.

Int J Vitam Nutr Res 2012 Jun;82(3):144-7

Institute of Nutritional Sciences, University of Vienna, AT-1090 Vienna, Austria.

A high-quality diet is one of the foundations of health and well-being. For a long time in human history, diet was chiefly a source of energy and macronutrients meant to still hunger and give the strength for work and activities that were in general much harder than nowadays. Only few persons could afford to emphasize enjoyment. In the assessment of quality, organoleptic properties were major criteria to detect spoilage and oxidative deterioration of food. Today, food hygiene is a quality aspect that is often taken for granted by consumers, despite its lack being at the origin of most food-borne diseases. The discovery of micronutrients entailed fundamental changes of the concept of diet quality. However, non-essential food components with additional health functions were still barely known or not considered important until recently. With the high burden of obesity and its associated diseases on the rise, affluent, industrialized countries have developed an increased interest in these substances, which has led to the development of functional foods to optimize special body functions, reduce disease risk, or even contribute to therapeutic approaches. Indeed, nowadays, high contents of energy, fat, and sugar are factors associated with a lower quality of food, and products with reduced amounts of these components are valued by many consumers. At the same time, enjoyment and convenience are important quality factors, presenting food manufacturers with the dilemma of reconciling low fat content and applicability with good taste and appealing appearance. Functional foods offer an approach to address this challenge. Deeper insights into nutrient-gene interactions may enable personalized nutrition adapted to the special needs of individuals. However, so far, a varied healthy diet remains the best basis for health and well-being.
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http://dx.doi.org/10.1024/0300-9831/a000104DOI Listing
June 2012

Long-term consequences of iron-fortified flour consumption in nonanemic men.

Ann Nutr Metab 2012 17;60(2):115-21. Epub 2012 Mar 17.

Institute of Nutritional Sciences, University of Vienna, Vienna, Austria.

Background/aims: Despite the advantages of fortifying flour with iron, there are still special concerns regarding the possible adverse effects of the extra iron consumed by nonanemic individuals. This study aimed to investigate the oxidative stress and iron status following 8 and 16 months of consumption of iron-fortified flour in nonanemic men.

Methods: In a before-and-after intervention study, 78 nonanemic apparently healthy 40- to 65-year-old men were randomly selected from Semnan, in the northeast of Iran. Data were collected at three time points. Evaluation of oxidative stress biomarkers as well as the assessment of iron status was performed in all three stages. After baseline data collection, the flour fortification program was started with 30 mg/kg iron as ferrous sulfate.

Results: After 16 months, serum iron levels had significantly increased from 102.9 ± 31.5 μg/dl (baseline) to 117.2 ± 29.8 μg/dl (p < 0.001). The mean total antioxidant capacity (1.71 ± 0.10 μM) was significantly lower than that at baseline (1.83 ± 0.17 μM; p < 0.01). Among other oxidative stress biomarkers, only superoxide dismutase and glutathione peroxidase activity increased significantly compared to the beginning of the study (p < 0.001 and p < 0.001, respectively). The results of this study did not show any symptoms of iron overload after 8 and 16 months.

Conclusions: Our data did not support the safety of flour fortification with 30 mg/kg iron as ferrous sulfate as a community-based approach to control iron deficiency in nonanemic healthy men.
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http://dx.doi.org/10.1159/000336184DOI Listing
August 2012