Publications by authors named "Susan I Barr"

122 Publications

Daily Oral Supplementation with 60 mg of Elemental Iron for 12 Weeks Alters Blood Mitochondrial DNA Content, but Not Leukocyte Telomere Length in Cambodian Women.

Nutrients 2021 May 31;13(6). Epub 2021 May 31.

Food, Nutrition and Health, University of British Columbia, 2205 East Mall, Vancouver, BC V6T 1Z4, Canada.

There is limited evidence regarding the potential risk of untargeted iron supplementation, especially among individuals who are iron-replete or have genetic hemoglobinopathies. Excess iron exposure can increase the production of reactive oxygen species, which can lead to cellular damage. We evaluated the effect of daily oral supplementation on relative leukocyte telomere length (rLTL) and blood mitochondrial DNA (mtDNA) content in non-pregnant Cambodian women (18-45 years) who received 60 mg of elemental iron as ferrous sulfate ( = 190) or a placebo ( = 186) for 12 weeks. Buffy coat rLTL and mtDNA content were quantified by monochrome multiplex quantitative polymerase chain reaction. Generalized linear mixed-effects models were used to predict the absolute and percent change in rLTL and mtDNA content after 12 weeks. Iron supplementation was not associated with an absolute or percent change in rLTL after 12 weeks compared with placebo (ß-coefficient: -0.04 [95% CI: -0.16, 0.08]; 0.50 and ß-coefficient: -0.96 [95% CI: -2.69, 0.77]; 0.28, respectively). However, iron supplementation was associated with a smaller absolute and percent increase in mtDNA content after 12 weeks compared with placebo (ß-coefficient: -11 [95% CI: -20, -2]; = 0.02 and ß-coefficient: -11 [95% CI: -20, -1]; = 0.02, respectively). Thus, daily oral iron supplementation for 12 weeks was associated with altered mitochondrial homeostasis in our study sample. More research is needed to understand the risk of iron exposure and the biological consequences of altered mitochondrial homeostasis in order to inform the safety of the current global supplementation policy.
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http://dx.doi.org/10.3390/nu13061877DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8227094PMC
May 2021

Baseline Hemoglobin, Hepcidin, Ferritin, and Total Body Iron Stores are Equally Strong Diagnostic Predictors of a Hemoglobin Response to 12 Weeks of Daily Iron Supplementation in Cambodian Women.

J Nutr 2021 Aug;151(8):2255-2263

BC Children's Hospital Research Institute, Vancouver, Canada.

Background: The WHO recommends daily iron supplementation for all women in areas where the population-level anemia prevalence is ≥40%, despite the fact that hemoglobin (Hb) concentration is generally considered to be a poor prognostic indicator of iron status.

Objectives: In this secondary analysis, we investigated the predictive power of ten baseline hematological biomarkers towards a 12-week Hb response to iron supplementation.

Methods: Data were obtained from a randomized controlled trial of daily iron supplementation in 407 nonpregnant Cambodian women (18-45 years) who received 60 mg elemental iron as ferrous sulfate for 12 weeks. Ten baseline biomarkers were included: Hb, measured with both a hematology analyzer and a HemoCue; inflammation-adjusted ferritin; soluble transferrin receptor; reticulocyte Hb; hepcidin; mean corpuscular volume; inflammation-adjusted total body iron stores (TBIS); total iron binding capacity; and transferrin saturation. Receiver operating characteristic (ROC) curves from fitted logistic regression models were used to make discrimination comparisons and variable selection methods were used to construct a multibiomarker prognostic model.

Results: Only 25% (n = 95/383) of women who completed the trial experienced a 12-week Hb response ≥10 g/L. The strongest univariate predictors of a Hb response were Hb as measured with a hematology analyzer, inflammation-adjusted ferritin, hepcidin, and inflammation-adjusted TBIS (AUCROC = 0.81, 0.83, 0.82, and 0.82, respectively), and the optimal cutoffs to identify women who were likely to experience a Hb response were 117 g/L, 17.3 μg/L, 1.98 nmol/L, and 1.95 mg/kg, respectively. Hb as measured with a hematology analyzer, inflammation-adjusted ferritin, and hepcidin had the best combined predictive ability (AUCROC=0.86). Hb measured with the HemoCue had poor discrimination ability (AUCROC = 0.65).

Conclusions: Baseline Hb as measured with a hematology analyzer was as strong a predictor of Hb response to iron supplementation as inflammation-adjusted ferritin, hepcidin, and inflammation-adjusted TBIS. This is positive given that the WHO currently uses the population-level anemia prevalence to guide recommendations for untargeted iron supplementation.
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http://dx.doi.org/10.1093/jn/nxab108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8349118PMC
August 2021

Telehealth coaching to improve self-management for secondary prevention after stroke: A randomized controlled trial of Stroke Coach.

Int J Stroke 2021 May 27:17474930211017699. Epub 2021 May 27.

Department of Physical Therapy, 8166The University of British Columbia, Vancouver, Canada.

Background: Stroke Coach is a lifestyle coaching telehealth program to improve self-management of stroke risk factors.

Aims: To examine the efficacy of Stroke Coach on lifestyle behavior and risk factor control among community-living stroke survivors within one-year post stroke.

Methods: Participants were randomized to Stroke Coach or an attention control Memory Training group. Lifestyle behavior was measured using the Health Promoting Lifestyle Profile II. Secondary outcomes included specific behavioral and cardiometabolic risk factors, health-related quality of life (HRQoL), cognitive status, and depressive symptoms. Measurements were taken at baseline, post-intervention (6 months), and retention (12 month). Linear mixed-effects models were used to test the study hypotheses (p < 0.05). All analyses were intention-to-treat.

Results: The mean age of the Stroke Coach (n = 64) and Memory Training (n = 62) groups was 67.2 and 69.1 years, respectively. The majority of participants (n = 100) had mild stroke (modified Rankin Scale = 1 or 2), were active, with controlled blood pressure (mean = 129/79 mmHg) at baseline. At post-intervention, there were no significant differences in lifestyle (b = -2.87; 95%CI - 8.03 to 2.29; p = 0.28). Glucose control, as measured by HbA1c (b = 0.17; 95%CI 0.17 to 0.32; p = 0.03), and HRQoL, measured using SF-36 Physical Component Summary (b = -3.05; 95%CI -5.88 to -0.21; p = 0.04), were significantly improved in Stroke Coach compared to Memory Training, and the improvements were maintained at retention.

Conclusion: Stroke Coach did not improve lifestyle behavior; however, there were improvements to HbA1c and HRQoL among community-living stroke survivors with mild stroke-related disability. (ClinicalTrials.gov identifier: NCT02207023).
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http://dx.doi.org/10.1177/17474930211017699DOI Listing
May 2021

Dietary Riboflavin Intake and Riboflavin Status in Young Adult Women Living in Metro Vancouver, Canada.

Curr Dev Nutr 2021 Apr 13;5(4):nzab021. Epub 2021 Mar 13.

Women and Kids Theme, South Australian Health and Medical Research Institute, and Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia, Australia.

Background: Nutrition surveys suggest that <10% of Canadian adults have inadequate riboflavin intakes. However, biochemical riboflavin deficiency [erythrocyte glutathione reductase activity coefficient (EGRac) ≥1.40] has been reported in 41% of young adult women living in Metro Vancouver. Canadian Chinese ethnicity comprise >25% of Vancouver's population and are postulated to have poorer riboflavin status than those of European ethnicity because they could be less likely to consume dairy products and fortified wheat.

Objectives: The objectives of this study were to determine dietary riboflavin intake and food sources, and to assess the association between riboflavin intake and status in young women of European (= 107) and Chinese (= 91) ethnicities living in Metro Vancouver, Canada.

Methods: This was a cross-sectional study conducted in women (aged 19-45 y). Women were healthy, not pregnant or breastfeeding, of European or Chinese ethnicities, and not taking riboflavin-containing supplements for the past 4 mo. Dietary riboflavin intake was assessed using the past-year Diet History Questionnaire II, and riboflavin status (EGRac) was measured in fasting venous blood samples.

Results: Only 7% of participants had dietary riboflavin intakes below the Estimated Average Requirement (0.9 mg/d), but 40% of women had biochemical riboflavin deficiency (EGRac ≥1.40). Although more Canadian women of European ethnicity than Chinese ethnicity had biochemical riboflavin deficiency (46% and 34%;  < 0.001), median dietary riboflavin intake did not differ (1.73 and 1.82 mg/d; = 0.587). Dairy products and vegetables contributed the most to riboflavin intake. Energy-adjusted dietary riboflavin intake was inversely associated with EGRac (B = -0.04, 95% CI: -0.07, -0.01). However, after further adjustment the relation was not significant.

Conclusions: Overall, women of reproductive age living in Metro Vancouver, Canada, had a low prevalence of inadequate dietary riboflavin intake despite the high prevalence of apparent biochemical riboflavin deficiency.
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http://dx.doi.org/10.1093/cdn/nzab021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035065PMC
April 2021

Automated E-Counseling for Chronic Heart Failure: CHF-CePPORT Trial.

Circ Heart Fail 2021 01 19;14(1):e007073. Epub 2021 Jan 19.

University of Ottawa Heart Institute, ON, Canada (L.M.M.).

Background: International task force statements advocate telehealth programs to promote health-related quality of life for patients with chronic heart failure (CHF). To that end, we evaluated the efficacy and usability of an automated e-counseling program.

Methods: This Canadian multi-site double-blind randomized trial assessed whether usual care plus either internet-based e-counseling (motivational and cognitive-behavioral tools for CHF self-care) or e-based conventional CHF self-care education (e-UC) improved 12-month Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS). Secondary outcomes included program engagement (total logon weeks, logons, and logon hours), total CHF self-care behaviors, diet (fruit and vegetable servings), 6-minute walk test, and 4-day step count. The association between program engagement and health-related quality of life was assessed using KCCQ-OS tertiles.

Results: We enrolled 231 patients, median age =59.5 years, 22% female, and elevated median KCCQ-OS=83.0 (interquartile range, 68-93). KCCQ-OS increase ≥5 points was not more prevalent for e-counseling, n=29 (29.6%) versus e-UC, n=32 (34.0%), =0.51. E-Counseling versus e-UC increased total logon weeks (=0.02), logon hours (=0.001), and logons (<0.001). Only e-counseling showed a positive association between 12-month KCCQ-OS tertile and logon weeks (=0.04) and logon hours (=0.004). E-Counseling increased CHF self-care behavior and diet but not 6-minute walk test or 4-day step count.

Conclusions: The primary KCCQ-OS end point was negative for this trial. Only e-counseling showed a positive association between program engagement and 12-month KCCQ-OS tertile, and it improved CHF self-care behavior and diet. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01864369.
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http://dx.doi.org/10.1161/CIRCHEARTFAILURE.120.007073DOI Listing
January 2021

Dietary Assessment Methodology in Response to September 2020 Issue.

J Acad Nutr Diet 2021 02 24;121(2):213. Epub 2020 Nov 24.

Tufts University School of Medicine, Boston, MA.

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http://dx.doi.org/10.1016/j.jand.2020.10.020DOI Listing
February 2021

Correction: Breakfast in Canada: Prevalence of Consumption, Contribution to Nutrient and Food Group Intakes, and Variability across Tertiles of Daily Diet Quality. A Study from the International Breakfast Research Initiative. 2018, , 985.

Nutrients 2020 Sep 2;12(9). Epub 2020 Sep 2.

Bell Institute of Health and Nutrition, General Mills, Minneapolis, MN 55427-3870, USA.

The authors wish to make a correction to the published version of their paper [...].
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http://dx.doi.org/10.3390/nu12092675DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551313PMC
September 2020

Health effects of vitamin and mineral supplements.

BMJ 2020 06 29;369:m2511. Epub 2020 Jun 29.

Friedman School of Nutrition Science and Policy, Tufts University, Boston, USA.

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http://dx.doi.org/10.1136/bmj.m2511DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322674PMC
June 2020

Is the 2019 Canada's Food Guide Snapshot nutritionally adequate?

Authors:
Susan I Barr

Appl Physiol Nutr Metab 2019 Dec 28;44(12):1387-1390. Epub 2019 Oct 28.

Food, Nutrition and Health, University of British Columbia, 2205 East Mall, Vancouver, BC V6T1Z4, Canada.

This analysis assessed the nutrient content of foods depicted in Canada's Food Guide Snapshot. Nutrient contents per 2000 kcal were initially assessed by comparison to Daily Values (DVs). For essential nutrients provided in amounts 90%. Canadians who consume foods as depicted in the Food Guide Snapshot are likely to fall below dietary requirements for calcium and vitamin D.
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http://dx.doi.org/10.1139/apnm-2019-0432DOI Listing
December 2019

Examining differences in school hour and school day dietary quality among Canadian children between 2004 and 2015.

Public Health Nutr 2019 11 26;22(16):3051-3062. Epub 2019 Aug 26.

Food, Nutrition and Health Program, 2205 East Mall, The University of British Columbia, Vancouver, British Columbia, Canada, V6T 1Z4.

Objective: The present study aimed to: (i) evaluate changes in Canadian children's dietary quality during school hours and on school days between 2004 and 2015; and (ii) explore whether changes in dietary quality over time were moderated by sociodemographic characteristics.

Design: Nationally representative 24 h dietary recall data were obtained from the 2004 (n 4827) and 2015 (n 2447) Canadian Community Health Surveys. Dietary quality was measured using the Canadian Healthy Eating Index (C-HEI) which evaluates respondents' compliance with 2007 national dietary recommendations, and the school-HEI which assesses respondents' dietary quality during school hours. Multivariable regression models compared differences in dietary quality between 2004 and 2015. Interaction effects were used to test whether changes over time were moderated by sociodemographic characteristics (sex, age group, ethnicity, residential location, province of residence, parental education, food security status).

Setting: Canada.

Participants: Children aged 6-17 years.

Results: Mean school-HEI score rose from 51.3 to 58.0 points (maximum = 100) from 2004 to 2015 (P < 0.001). School-HEI sub-scores for total vegetables and fruit, whole fruit, dark green and orange vegetables, milk and alternatives, and meat and alternatives improved over time, but remained well below recommendations. Decreased energy from minimally nutritious foods accounted for 39 % of the improvement in mean school-HEI scores. Mean whole day C-HEI scores also improved (60.8 to 66.4 points, P < 0.001). There was no evidence of a moderating effect for any of the sociodemographic variables examined.

Conclusions: Mean dietary quality of Canadian children during school hours and on school days improved modestly for all age and sex groups but remained below 2007 national dietary recommendations.
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http://dx.doi.org/10.1017/S1368980019000788DOI Listing
November 2019

Suboptimal Biochemical Riboflavin Status Is Associated with Lower Hemoglobin and Higher Rates of Anemia in a Sample of Canadian and Malaysian Women of Reproductive Age.

J Nutr 2019 11;149(11):1952-1959

Department of Food, Nutrition, and Health, University of British Columbia, Vancouver, British Columbia, Canada.

Background: Riboflavin is required for several redox reactions. Clinical riboflavin deficiency occurs mainly in low-income countries, where it is associated with anemia. The functional significance of suboptimal riboflavin status in different populations and its role in anemia is not well understood.

Objectives: We assessed the biomarker status of riboflavin and its association with hemoglobin concentration and anemia in women living in Vancouver, Canada, and Kuala Lumpur, Malaysia.

Methods: Healthy nonpregnant, nonbreastfeeding women (19-45 y) were recruited from Canada ( n = 206) and Malaysia (n = 210) via convenience sampling. Fasting blood was collected to assess riboflavin status [erythrocyte glutathione reductase activity coefficient (EGRac)], hematological indicators, soluble transferrin receptor (sTfR), ferritin, vitamin A, folate, and vitamin B-12 concentrations. Linear and logistic regression models were used to assess the association of riboflavin status with hemoglobin concentration and anemia.

Results: EGRac (mean ± SD) values were higher, indicating poorer riboflavin status, in Malaysian compared with Canadian women (1.49 ± 0.17 compared with 1.38 ± 0.11). Likewise, riboflavin biomarker deficiency (EGRac ≥1.40) was significantly more prevalent among Malaysians than Canadians (71% compared with 40%). More Malaysian than Canadian women were anemic (hemoglobin <120 g/L; 18% compared with 7%). With use of linear regression (pooled sample; n = 416), EGRac values were negatively associated with hemoglobin concentration (r = -0.18; P < 0.001). This relation remained significant (P = 0.029) after adjusting for age, parity, ethnicity, vitamin B-12, folate, sTfR, ferritin, and vitamin A. Women with riboflavin deficiency (EGRac ≥1.40) were twice as likely to present with anemia (adjusted OR: 2.38; 95% CI: 1.08, 5.27) compared with women with EGRac <1.40.

Conclusions: Biochemical riboflavin deficiency was observed in Canadian and Malaysian women, with higher rates of deficiency among Malaysian women. Deficient biomarker status of riboflavin was a weak but significant predictor of hemoglobin and anemia, suggesting that the correction of riboflavin deficiency may potentially play a small protective role in anemia, but this requires further investigation.
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http://dx.doi.org/10.1093/jn/nxz151DOI Listing
November 2019

Including 60 mg Elemental Iron in a Multiple Micronutrient Supplement Blunts the Increase in Serum Zinc after 12 Weeks of Daily Supplementation in Predominantly Anemic, Nonpregnant Cambodian Women of Reproductive Age.

J Nutr 2019 09;149(9):1503-1510

Food, Nutrition, and Health, University of British Columbia, Vancouver, Canada.

Background: Multiple micronutrient (MMN) supplementation may result in interaction effects due to competing absorptive pathways of trace elements.

Objectives: The aim of this study was to investigate the effect of MMN supplementation with or without iron on serum zinc, selenium, and copper concentrations in Cambodian women.

Methods: In a 2 × 2 factorial double-blind randomized 12-wk trial, predominantly anemic, nonpregnant women (aged 18-45 y) received daily 60 mg of iron (Fe; n = 201); 14 other micronutrients including zinc (15 mg), selenium (65 μg), and copper (2 mg), but no iron (MMN; n = 202); 60 mg iron plus MMN (Fe + MMN; n = 206); or a placebo (n = 200). Fasting morning blood was collected at baseline and 12 wk from women in 26 villages in Kampong Chhnang province. Serum zinc, selenium, and copper concentrations (secondary outcomes of the randomized controlled trial) were measured using inductively coupled plasma mass spectrometry. Generalized linear regression was used to estimate intervention effects [β coefficient (95% CI)] for Fe (with or without MMN) and MMN (with or without Fe) after testing for the presence of an Fe × MMN interaction.

Results: A total of 760 women completed the trial. Zinc deficiency prevalence at baseline was 45% (inflammation-adjusted serum zinc <10.7 μmol/L). A significant Fe × MMN interaction (P = 0.02) was detected in the 2 × 2 analysis with serum zinc concentration as the outcome: the MMN group had a higher mean serum zinc concentration at 12 wk (12.3 μmol/L; 95% CI: 12.2, 12.4 μmol/L) compared with all other groups, and the Fe + MMN group had a higher mean serum zinc concentration (11.6 μmol/L; 95% CI: 11.5, 11.7 μmol/L) compared with the Fe group (11.0 μmol/L; 95% CI: 10.9, 11.0 μmol/L) and the placebo group (11.2 μmol/L; 95% CI: 11.1, 11.4 μmol/L).

Conclusions: The inclusion of 60 mg iron in the daily MMN formulation may be interfering with the absorption and/or metabolism of supplemental zinc in Cambodian women. This is of particular concern when MMN supplementation is implemented in populations with risk of zinc deficiency. This trial was registered at clinicaltrials.gov as NCT-02481375.
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http://dx.doi.org/10.1093/jn/nxz097DOI Listing
September 2019

Reference intervals for serum total vitamin B12 and holotranscobalamin concentrations and their change points with methylmalonic acid concentration to assess vitamin B12 status during early and mid-pregnancy.

Clin Chem Lab Med 2019 Oct;57(11):1790-1798

British Columbia Children's Hospital Research Institute, 950 W 28th Ave, Vancouver, BC V5Z 4H4, Canada.

Background Maternal vitamin B12 (B-12) adequacy is important for maternal health and optimal fetal growth. However, pregnancy-specific cut-offs for B-12 biomarkers are lacking. Methods Reference intervals for serum total B-12, holotranscobalamin (holoTC) and methylmalonic acid (MMA) concentrations were calculated following CLSI EP28-A3c guidelines in 723 pregnant women of European (50%) and South Asian (50%) ethnicity, residing in British Columbia, Canada, at median (range) 11.4 (8.3-13.9) and 16.1 (14.9-20.9) weeks of gestation. Change point analyses described relationships between log serum MMA concentration with serum total B-12 and holoTC concentrations, assuming linear-linear relationships. Results The central 95% reference interval limits indicated that serum total B-12 <89.9 and <84.0 pmol/L, holoTC <29.5 and <26.0 pmol/L and MMA >371 and >374 nmol/L, in the first and second trimesters, respectively, may indicate B-12 deficiency in pregnant women. The lower limits of total B-12 and holoTC and the upper limits of MMA significantly differed by ethnicity in both trimesters. According to the change point analysis, total B-12 <186 and <180 pmol/L and holoTC <62.2 and <67.5 pmol/L in the first and second trimesters, respectively, suggested an increased probability of impaired intracellular B-12 status, with no difference between ethnicities. Conclusions We present novel reference limits and change points for B-12 biomarkers, which may be employed to identify possible B-12 deficiency in women during early and mid-pregnancy. Future research is needed to validate these cut-offs and determine the predictors and functional outcomes associated with impaired B-12 status in ethnically diverse populations.
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http://dx.doi.org/10.1515/cclm-2018-1337DOI Listing
October 2019

Towards an Evidence-Based Recommendation for a Balanced Breakfast-A Proposal from the International Breakfast Research Initiative.

Nutrients 2018 Oct 18;10(10). Epub 2018 Oct 18.

Cereal Partners Worldwide, CH-1350 Orbe, Switzerland.

The International Breakfast Research Initiative (IBRI) set out to derive nutritional recommendations for a balanced breakfast using a standardized analysis of national nutrition surveys from Canada, Denmark, France, Spain, UK and the US. In all countries, the frequency of breakfast consumption by age was high and U-shaped with children and older adults having a higher frequency of breakfast consumption. Breakfast contributed 16% to 21% of daily energy intake. In all countries, breakfast was a carbohydrate- and nutrient-rich meal, providing more carbohydrates (including sugars), thiamin, riboflavin, folate, calcium, potassium, and magnesium, and less vitamin A, fats and sodium relative to its contribution to daily energy intakes. Breakfast consumers were stratified by tertiles of the Nutrient Rich Foods (NRF) index, used as a measure of diet quality. Breakfast intakes associated with the top tertile of NRF, along with the Codex Alimentarius international food standards and World Health Organization (WHO) diet guidelines, were used to derive the proposed nutrient recommendations. The goal was to preserve the nutrient density of existing breakfasts, while addressing concerns regarding added sugars, saturated fats, dietary fiber, and vitamin D. This initiative is unique in seeking to derive nutrient recommendations for a specific meal using the observed nutritional profile of such meal.
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http://dx.doi.org/10.3390/nu10101540DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213610PMC
October 2018

Dietary Choline Intake: Current State of Knowledge Across the Life Cycle.

Nutrients 2018 Oct 16;10(10). Epub 2018 Oct 16.

Food, Nutrition, and Health Program, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada.

Choline, an essential dietary nutrient for humans, is required for the synthesis of the neurotransmitter, acetylcholine, the methyl group donor, betaine, and phospholipids; and therefore, choline is involved in a broad range of critical physiological functions across all stages of the life cycle. The current dietary recommendations for choline have been established as Adequate Intakes (AIs) for total choline; however, dietary choline is present in multiple different forms that are both water-soluble (e.g., free choline, phosphocholine, and glycerophosphocholine) and lipid-soluble (e.g., phosphatidylcholine and sphingomyelin). Interestingly, the different dietary choline forms consumed during infancy differ from those in adulthood. This can be explained by the primary food source, where the majority of choline present in human milk is in the water-soluble form, versus lipid-soluble forms for foods consumed later on. This review summarizes the current knowledge on dietary recommendations and assessment methods, and dietary choline intake from food sources across the life cycle.
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http://dx.doi.org/10.3390/nu10101513DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213596PMC
October 2018

Changes in diet, and the relationship between diet and physical activity within and across the lifetime of current ultra-endurance exercisers.

J Sports Med Phys Fitness 2019 May 1;59(5):798-807. Epub 2018 Oct 1.

School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Australia.

Background: There is currently no information on the lifetime diet of ultra-endurance exercisers. This study describes changes in diet across the lifetime of current ultra-endurance exercisers and the relationship between diet and physical activity (specifically ultra-endurance exercise [UEE]).

Methods: Lifetime physical activity and diet were assessed in current ultra-endurance exercisers (N.=120; ages 21-74 years) over six life periods (5-12, 13-18, 19-30, 31-45, 46-60, 61-75 years). Using the life period having the largest absolute increase in UEE (IUEE), diet was assessed according to food category scores and dietary patterns. Changes in lifetime diet were described by comparing food category scores between adjacent life periods. Differences in food category scores were investigated between the life period for each IUEE group and the preceding life period and associations between dietary patterns and UEE were investigated within each IUEE group. Relationships between lifetime diet and UEE were investigated by examining associations between lifetime food category scores and lifetime UEE.

Results: The participant group had significant increases in all food category scores from 13-18 to 19-30 years and significant decreases in all food category scores from 19-30 to 31-45 years. UEE correlated negatively with the Western style dietary pattern in the IUEE19-30 group and positively with the fruit and vegetable dietary pattern in the IUEE31-45 group. There was a positive correlation between lifetime UEE and lifetime vegetables and fruit category scores.

Conclusions: The ultra-endurance exercisers in this study exhibited changes in diet similar to general populations, which appear to reflect typical nutritional requirements across the lifespan.
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http://dx.doi.org/10.23736/S0022-4707.18.08882-5DOI Listing
May 2019

Adequate vitamin B and riboflavin status from menus alone in residential care facilities in the Lower Mainland, British Columbia.

Appl Physiol Nutr Metab 2019 Apr 24;44(4):414-419. Epub 2018 Sep 24.

h Healthy Mothers, Babies and Children Theme, South Australia Health and Medical Research Institute, North Terrace, Adelaide SA 5000, Australia.

Older adults have potential increased risk of nutrient deficiencies because of age-related decreased dietary intake and malabsorption; it is important to ensure nutrient needs are met to avoid adverse health outcomes. B vitamins are of particular interest: vitamin B deficiency can cause irreversible neurodegeneration; there is mandatory folic acid fortification in Canada; and suboptimal riboflavin status has been reported among older adults in the United Kingdom. In this exploratory secondary analysis study we assessed vitamin B and riboflavin biochemical status (via microparticle enzyme immunoassay and erythrocyte glutathione reductase activity coefficient (EGRac), respectively), and the vitamin B, riboflavin, and folate content of menus served to a convenience sample of older adults (≥65 years) from 5 residential care facilities within the Lower Mainland of British Columbia, Canada. Diet was assessed from customized 28-day cycle meal plans. Participants (n = 207; 53 men and 154 women) were aged 86 ± 7 years, largely of European descent (92%), and nonsmokers (95%). The menus served had a low prevalence of inadequacy for vitamin B and riboflavin (only 4% and 1% of menus contained less than the estimated average requirement (EAR), respectively), but 93% contained less than the EAR for folate. Mean ± SD serum total vitamin B concentration was 422 ± 209 pmol/L, and EGRac was 1.30 ± 0.19. The majority of older adults in residential care were provided with adequate vitamin B and riboflavin menu amounts, and only 5% were vitamin B deficient (<148 pmol/L). However, 26% were riboflavin deficient (EGRac ≥ 1.4), which may warrant further investigation.
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http://dx.doi.org/10.1139/apnm-2018-0459DOI Listing
April 2019

Variations in plasma choline and metabolite concentrations in healthy adults.

Clin Biochem 2018 Sep 17;60:77-83. Epub 2018 Aug 17.

Food, Nutrition, and Health Program, University of British Columbia, 2205 East Mall, Vancouver, BC V6T 1Z4, Canada. Electronic address:

Background: Plasma concentrations of choline and its metabolites might serve as biomarkers for the health outcomes of several pathological states such as cardiovascular disease and cancer. However, information about the reliability of biomarkers of choline status is limited. We investigated biological variations in repeated measures of choline and metabolites in healthy adults to assess them as biomarkers.

Methods: Blood samples were collected after an overnight fast at three-time points 12 days apart from 40 adults (mean age, 33 y; male, n = 21). A subset (n = 19; [male, n = 8]) provided one additional sample after a breakfast meal. Plasma free choline, betaine and dimethylglycine were measured using liquid chromatography-tandem mass spectrometry, and plasma phosphatidylcholine, sphingomyelin and lysophosphatidylcholine were measured using high-performance liquid chromatography.

Results: The biological variations observed for choline and metabolites were ≤ 13% for adult fasting samples. This corresponded to intra-class correlations (ICC) that ranged from 0.593 to 0.770 for fasting values for choline and metabolites. A similar ICC range was also obtained between fasting and post-prandial states. Although most post-prandial concentrations of choline and metabolites were significantly higher (P < .05) than fasting, all fell within a calculated reference interval. The participants were correctly classified in tertiles for fasting and post-prandial states for choline (68%) and metabolites (range = 32% phosphatidylcholine and 79% for sphingomyelin).

Conclusions: These findings indicate that biological variations of choline and metabolites are low in healthy adults and values from a single blood sample can be used as a biomarker. However, choosing phosphatidylcholine as a biomarker is less reliable.
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http://dx.doi.org/10.1016/j.clinbiochem.2018.08.002DOI Listing
September 2018

Breakfast in Canada: Prevalence of Consumption, Contribution to Nutrient and Food Group Intakes, and Variability across Tertiles of Daily Diet Quality. A Study from the International Breakfast Research Initiative.

Nutrients 2018 Jul 27;10(8). Epub 2018 Jul 27.

Bell Institute of Health, Nutrition and Food Safety, General Mills, Minneapolis, MN 55427-3870, USA.

This study used 24-h recall data from the nationally representative 2015 Canadian Community Health Survey-Nutrition to assess breakfast intake among Canadians aged 6⁻12 years ( = 2331), 13⁻17 years ( = 2026), 18⁻54 years ( = 7651), and 55+ years ( = 6279). Overall, 90% consumed breakfast; breakfast consumers reported higher intakes of energy and key nutrients and had higher daily diet quality scores assessed using the Nutrient-Rich Foods Index 9.3 (NRF 9.3). Among breakfast consumers ( = 16,484), breakfast contributed a mean of 389 kcal (1628 kJ) and 21.6% of daily energy intake. Relative to its contribution to energy, breakfast contributed higher intakes of fruit, whole grains, and fluid milk, as well as associated nutrients (e.g., carbohydrate, total sugars, fiber, calcium, and vitamin D). Among breakfast consumers classified by daily dietary quality (NRF 9.3 score), energy intake at breakfast did not differ across tertiles for either children or adults. However, intakes of key nutrients, fiber, and total sugars increased across tertiles, and among adults, intakes of saturated fat and sodium decreased. Mean intakes of fruit, whole grains, and fluid milk also increased across tertiles, as did the proportion of individuals consuming these foods; higher fruit and milk intakes may explain higher sugar intakes as diet quality increased. Promoting the consumption of these foods at breakfast could contribute to improved diet quality among Canadians.
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http://dx.doi.org/10.3390/nu10080985DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6116091PMC
July 2018

Randomized Controlled Trial of E-Counseling for Hypertension: REACH.

Circ Cardiovasc Qual Outcomes 2018 07;11(7):e004420

Peter Munk Cardiac Centre (R.P.N., R.T., J.S.).

Background: The efficacy of internet-based interventions to improve hypertension management is not established. We evaluated the therapeutic benefit of e-counseling by adapting best evidence guidelines for behavioral counseling.

Methods And Results: This multicenter double-blind randomized controlled trial included assessments at baseline, 4 months, and 12 months. Participants were 35 to 74 years of age and diagnosed with hypertension: systolic/diastolic blood pressure (BP) 130 to 180/85 to 110 mm Hg. BP was assessed by automated office measurement. E-Counseling used multimedia and interactive tools to increase motivation and skill for self-care (exercise, diet, medication adherence, and smoking cessation). Control used self-care education. Frequency of contact by our e-platform was equal for both trial arms. Primary end points were change at 4 and 12 months in systolic BP, diastolic BP, pulse pressure, total lipoprotein cholesterol, low-density lipoprotein cholesterol, total lipoprotein cholesterol/high-density lipoprotein cholesterol ratio, non-high-density lipoprotein cholesterol, and Framingham 10-year cardiovascular risk index. Intention-to-treat analysis used generalized linear models adjusted for baseline measures, sex, and medications. Among 264 participants, mean age was 57.6 years (SE, 0.6), 58% were women, with 83% on antihypertensive medications. At 12 months, e-counseling versus control evoked greater reduction in systolic BP (-10.1 mm Hg [95% confidence interval (CI), -12.5, -7.6] versus -6.0 mm Hg [95% CI, -8.5, -3.5]; =0.02); pulse pressure (-5.2 mm Hg [95% CI, -6.9, -3.5] versus -2.7 mm Hg [95% CI, -4.5, -0.9]; =0.04), and Framingham risk index (-1.9% [95% CI, -3.3, -0.5] versus -0.02% [95% CI, -1.2, 1.7]; =0.02), respectively. Among males in e-counseling versus control, 12-month end points included lower diastolic BP (=0.01), non-high-density lipoprotein cholesterol (=0.04), total lipoprotein cholesterol (=0.03), and a trend for total lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (=0.07).

Conclusions: To our knowledge, this is the first double-blind randomized trial of e-counseling for hypertension. Added benefit for medical therapy was achieved by combining available technology with a clinically organized protocol of motivational and cognitive-behavioral counseling.

Clinical Trial Registration: https://www.clinicaltrials.gov; Unique identifier: NCT01541540.
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http://dx.doi.org/10.1161/CIRCOUTCOMES.117.004420DOI Listing
July 2018

Adult Premenopausal Bone Health Related to Reproductive Characteristics-Population-Based Data from the Canadian Multicentre Osteoporosis Study (CaM).

Int J Environ Res Public Health 2018 05 18;15(5). Epub 2018 May 18.

Centre for Menstrual Cycle and Ovulation Research; University of British Columbia, Vancouver, BC V5Z 1M9, Canada.

Amenorrhea is important for women's bone health. However, few have reported reproductive, anthropometric (body mass index [BMI], height) and bone health (areal bone mineral density [BMD], prevalent fractures) in a population-based study. The purposes of this cross-sectional study of women in the randomly-selected Canadian Multicentre Osteoporosis Study (CaM) population were: (1) to describe reproductive, demographic, anthropometric and lifestyle variables; and (2) in menstruating women, to relate reproductive and other variables to BMD at the lumbar spine (L1-4, LS), femoral neck (FN) and total hip (TH) sites and to prevalent fragility fractures. This study describes the reproductive characteristics of 1532 women aged 30⁻60 years. BMD relationships with reproductive and other variables were described in the 499 menstruating women. Mean menarche age was 12.8 years, 96% of women were parous and 95% had used combined hormonal contraceptives (CHC). Infertility was reported by 9%, androgen excess by 13%, amenorrhea by 8% and nulliparity by 4%. LS BMD was negatively associated with amenorrhea and androgen excess and positively related to current BMI and height. A later age at menarche negatively related to FN BMD. BMI and height were strongly related to BMD at all sites. Prevalent fragility fractures were significantly associated with quartiles of both LS and TH BMD.
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http://dx.doi.org/10.3390/ijerph15051023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5982062PMC
May 2018

Breakfast in Human Nutrition: The International Breakfast Research Initiative.

Nutrients 2018 May 1;10(5). Epub 2018 May 1.

Cereal Partners Worldwide, CH-1350 Orbe, Switzerland.

Breakfast is often referred to as the most important meal of the day and in recent years has been implicated in weight control, cardio-metabolic risk factors and cognitive performance although, at present, the literature remains inconclusive as to the precise health benefits of breakfast. There are extensive reports of breakfast’s contributions to daily food and nutrient intakes, as well as many studies that have compared daily food and nutrient intakes by breakfast consumers and skippers. However, significant variation exists in the definitions of breakfast and breakfast skippers, and in methods used to relate breakfast nutrient intakes to overall diet quality. The present review describes a novel and harmonised approach to the study of the nutritional impact of breakfast through The International Breakfast research Initiative involving national dietary survey data from Canada, Denmark, France, Spain, the UK and the USA. It is anticipated that the analysis of such data along harmonised lines, will allow the project to achieve its primary goal of exploring approaches to defining optimal breakfast food and nutrient intakes. Such data will be of value to public health nutrition policy-makers and food manufacturers and will also allow consistent messaging to help consumers to optimize food choices at breakfast.
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http://dx.doi.org/10.3390/nu10050559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986439PMC
May 2018

The Use of Multivitamin/Multimineral Supplements: A Modified Delphi Consensus Panel Report.

Clin Ther 2018 04 21;40(4):640-657. Epub 2018 Mar 21.

Institute of Nutrition and Health, Qingdao University, Qingdao, China.

Purpose: Evidence supporting the use of dietary supplements, in particular, multivitamin/multimineral supplements (MVMS), has been mixed, complicating the ability of health care professionals to recommend their use. To clarify the role that MVMS can play in supporting human health, a series of consensus statements was developed based on expert opinion.

Methods: A panel of 14 international experts in nutritional science and health care was convened to develop consensus statements related to using MVMS in supporting optimal human health. The modified Delphi process included 2 rounds of remote voting and a final round of voting at a roundtable meeting where evidence summaries were presented and discussed. The level of agreement with each of 9 statements was rated on a 5-point Likert scale: agree strongly; agree with reservation; undecided; disagree; or disagree strongly. Consensus was predefined as ≥80% of the panel agreeing strongly or agreeing with reservation to a given statement.

Findings: Consensus was reached for all statements. The panel determined that MVMS can broadly improve micronutrient intakes when they contain at least the micronutrients that are consumed insufficiently or have limited bioavailability within a specified population. MVMS formulations may also be individualized according to age, sex, life cycle, and/or other selected characteristics. There are specific biological processes and health outcomes associated with deficient, inadequate, and adequate micronutrient levels. Adequate intake is necessary for normal biological functioning required for good health; in some instances, higher than recommended micronutrient intakes have the potential to provide additional health benefits. Meeting daily intakes established by dietary reference values should be an explicit public health goal for individuals and populations. Use of MVMS is one approach to ensure that adequate micronutrient needs are met in support of biological functions necessary to maintain health. Long-term use of MVMS not exceeding the upper limit of recommended intakes has been determined to be safe in healthy adults. There is insufficient evidence to indicate that MVMS are effective for the primary prevention of chronic medical conditions, including cardiovascular disease and cancer. However, for certain otherwise healthy subpopulations (eg, pregnant women, older adults) and some individuals with existing medical conditions who experience inadequacies in micronutrient intake, addressing inadequacies by using MVMS can provide health benefits.

Implications: This consensus panel has described key issues related to the use of MVMS among individuals at risk of or presenting with inadequacies in micronutrient intake or biomarker status.
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http://dx.doi.org/10.1016/j.clinthera.2018.02.014DOI Listing
April 2018

Concentrations of Water-Soluble Forms of Choline in Human Milk from Lactating Women in Canada and Cambodia.

Nutrients 2018 Mar 20;10(3). Epub 2018 Mar 20.

Food, Nutrition, and Health Program, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada.

Choline has critical roles during periods of rapid growth and development, such as infancy. In human milk, choline is mostly present in water-soluble forms (free choline, phosphocholine, and glycerophosphocholine). It is thought that milk choline concentration is influenced by maternal choline intake, and the richest food sources for choline are of animal origin. Scarce information exists on milk choline from countries differing in animal-source food availability. In this secondary analysis of samples from previous trials, the concentrations of the water-soluble forms of choline were quantified by liquid chromatography-tandem mass spectrometry in mature milk samples collected from lactating women in Canada ( = 301) and in Cambodia ( = 67). None of the water-soluble forms of choline concentrations in milk differed between Canada and Cambodia. For all milk samples ( = 368), free choline, phosphocholine, glycerophosphocholine, and the sum of water-soluble forms of choline concentrations in milk were (mean (95%CI)) 151 (141, 160, 540 (519, 562), 411 (396, 427), and 1102 (1072, 1133) µmol/L, respectively. Theoretically, only 19% of infants would meet the current Adequate Intake (AI) for choline. Our findings suggest that the concentrations in milk of water-soluble forms of choline are similar in Canada and Cambodia, and that the concentration used to set the infant AI might be inaccurate.
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http://dx.doi.org/10.3390/nu10030381DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872799PMC
March 2018

The home food environment and associations with dietary intake among adolescents presenting for a lifestyle modification intervention.

BMC Nutr 2018 6;4. Epub 2018 Feb 6.

6School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z9 Canada.

Background: The home food environment may be an important target for addressing adolescent obesity. The aim of this study was to investigate associations between aspects of the home food environment and the diets of adolescents who present for obesity treatment.

Methods: Cross-sectional baseline data were collected from 167 overweight/obese adolescent-parent pairs participating in an e-health lifestyle modification intervention. Adolescent intake of specific foods (fruit and vegetables, total fat, sugar-sweetened beverages, desserts/treats, and snacking occasions) was assessed by three 24-h dietary recalls, while household factors were collected from adolescent and parent questionnaires. Structural Equation Modeling, controlling for relevant covariates, was used to examine the relationship between adolescent diet and the following household factors: parent modeling, parenting style, family meal practices, and home food/beverage availability.

Results: Findings reveal that few characteristics of the home food environment were associated with adolescent dietary intake. Greater home availability of high-fat foods was moderately associated with adolescent snack intake (β = 0.27,  < .001). Associations with fruit/vegetables and fat intake were small and some were in unexpected directions. Parent modeling of healthful food choices and healthier family meal practices were associated with lower availability of high-fat foods and treats in the home, but were not directly associated with adolescent diets.

Conclusions: Parent modeling of healthy foods and positive mealtime routines might contribute to the healthfulness of foods offered in the homes of adolescents who are overweight/obese. Additional research is needed to better characterize the complex aspects of the household environment that influence adolescent diet.
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http://dx.doi.org/10.1186/s40795-018-0210-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7050879PMC
February 2018

Effect of enhanced homestead food production and aquaculture on dietary intakes of women and children in rural Cambodia: A cluster randomized controlled trial.

Matern Child Nutr 2018 07 5;14(3):e12581. Epub 2018 Jan 5.

Faculty of Land and Food Systems, Department of Human Nutrition, University of British Columbia, Vancouver, British Columbia, Canada.

The Cambodian diet is low in nutrient-dense animal-source foods. Enhanced homestead food production (EHFP) and aquaculture, which increase availability of nutrient-dense foods, are promising interventions to improve dietary intake. This study examined the effect of EHFP with or without aquaculture on dietary intake and prevalence of inadequate intake of select nutrients among women and children living in rural Cambodia, compared to controls. In a registered, cluster randomized controlled trial in Prey Veng, Cambodia, 10 households in each of 90 villages (n = 900) were randomized by village to receive EHFP, EHFP plus aquaculture, or control. After 22-month intervention, 24-hr dietary recalls (24HRs) were collected from mothers aged 18-50 years (n = 429) and their children aged 6 months-7 years (n = 421), reported by their mothers. Usual intake distributions (generated using 24HRs and repeat 24HRs on a subsample) were used to estimate prevalence of inadequate intake. Compared to controls, women in the EHFP group had significantly higher zinc (+1.0 mg/d) and Vitamin A (+139 retinol activity equivalents/d) intakes, and women in the EHFP plus aquaculture group had significantly higher iron (+2.7 mg/d), Vitamin A (+191 retinol activity equivalents/d), and riboflavin (+0.17 mg/d) intakes. Women in the EHFP plus aquaculture group also had significantly lower prevalence of inadequate iron (-7%, at 10% bioavailability), Vitamin A (-19%), and riboflavin (-17%) intakes, compared to controls. No significant differences in intakes or nutrient adequacy were observed among children or between EHFP and EHFP plus aquaculture groups. The biological importance of the small differences in nutrient intakes among women remains to be established.
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http://dx.doi.org/10.1111/mcn.12581DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6866186PMC
July 2018

Enhancing nutrition with pulses: defining a recommended serving size for adults.

Nutr Rev 2017 Dec;75(12):990-1006

Pathfinders Research & Management Ltd, Saskatoon, Saskatchewan, Canada.

Pulses, defined as dry-harvested leguminous crops, include several varieties of beans, peas, lentils, and chickpeas. There is no consensus around a recommended serving size of pulses within a balanced diet, which prevents the development of transregional strategies that rely on consistent messaging to drive increases in consumption. The purpose of this review is to define and disseminate an appropriate target for a minimum serving size of pulses on any given day that can be used in international or collaborative strategies to promote the consumption of pulses. Relevant data were reviewed to examine dietary guidelines across jurisdictions, determine consumption levels of pulses across the globe, evaluate the nutritional composition of pulses in the context of dietary nutrient insufficiency, and assess the impact of pulses on dietary quality. Across a variety of pulses, 100 g of cooked pulses aligned with most regional serving sizes for pulses and provides significant levels of nutrients that are underconsumed by specific age-sex groups. Moreover, 100 g of pulses provides a number of nutrients that qualify for nutrient content claims under regional regulatory frameworks. The data demonstrate that 100 g or 125 mL (0.5 metric cup) of cooked pulses is a reasonable target for aligning strategies that promote the dietary and nutritional attributes of these legumes.
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http://dx.doi.org/10.1093/nutrit/nux058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5914352PMC
December 2017

Pregnant women of South Asian ethnicity in Canada have substantially lower vitamin B12 status compared with pregnant women of European ethnicity.

Br J Nutr 2017 Sep 18;118(6):454-462. Epub 2017 Sep 18.

1Food, Nutrition and Health, Faculty of Land and Food Systems,The University of British Columbia,2205 East Mall,Vancouver BC,V6T 1Z4,Canada.

Maternal vitamin B12 (B12) status has been inversely associated with adverse pregnancy outcomes and positively with fetal growth and infant development. South Asians, Canada's largest ethnic minority, are prone to B12 deficiency. Yet, data are lacking on B12 status in South Asian pregnant women in North America. We sought to determine B12 status, using multiple biomarkers, in 1st and 2nd trimester pregnant women of South Asian and, for comparison, European ethnicity living in Vancouver, Canada. In this retrospective cohort study, total B12, holotranscobalamin (holoTC), methylmalonic acid (MMA), and total homocysteine concentrations were quantified in two routinely collected (mean gestational week: 11·5 (range 8·3-13·9) and 16·5 (range 14·9-20·9)), banked serum samples of 748 healthy pregnant South Asian (n 371) and European (n 377) women. South Asian pregnant women had significantly lower B12 status than European pregnant women at both time points, as indicated by lower serum total B12 and holoTC concentrations, and higher MMA concentrations (all P≤0·001). The largest difference, which was substantial (Cohen's d≥0·5), was observed in mean serum total B12 concentrations (1st trimester: 189 (95 % CI 180, 199) v. 246 (95 % CI 236, 257) pmol/l; 2nd trimester: 176 (95 % CI 168, 185) v. 226 (95 % CI 216, 236) pmol/l). Further, South Asian ethnicity was a significant negative predictor of B12 status during pregnancy. South Asian women living in Vancouver have substantially lower B12 status during early pregnancy. Future research identifying predictors and health consequences of this observed difference is needed to allow for targeted interventions.
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http://dx.doi.org/10.1017/S0007114517002331DOI Listing
September 2017

A telehealth intervention to promote healthy lifestyles after stroke: The Stroke Coach protocol.

Int J Stroke 2018 02 4;13(2):217-222. Epub 2017 Sep 4.

1 Department of Physical Therapy, 8166 University of British Columbia , Vancouver, Canada.

Rationale Recurrent stroke is prevalent and associated with high mortality rates, disability, and social and economic costs. Adequate management of risk factors may reduce recurrent stroke; however, many stroke survivors have poor control of risk factors. We have developed a theoretically sound and evidence-based lifestyle modification program called the Stroke Coach, a telephone-based self-management program to improve control of risk factors. Hypothesis Individuals who participate in Stroke Coach will achieve more lifestyle improvements than individuals in an attention controlled Memory Training Program. Design In this single blind randomized controlled trial, 126 community-living stroke survivors will be randomized to Stroke Coach or the attention control group. Participants randomized to the six-month Stroke Coach will receive seven telephone lifestyle coaching sessions, self-management education and practice, and a self-monitoring kit, comprised of a health report card, with blood pressure and activity monitors. Study Outcomes The primary outcome will be measured using the Health Promoting Lifestyle Profile II. Secondary outcomes include behavioral and physiological risk factors, quality of life, cognitive status, health and social service use. Measurements will be taken at baseline, immediately after the intervention and six-month post-intervention. Summary The results of this trial will add to our understanding of the use of self-management to improve control of risk factors, and may facilitate the development of a larger trial evaluating the effect of Stroke Coach on endpoints such as recurrent stroke or cardiac events as the primary outcome.
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http://dx.doi.org/10.1177/1747493017729266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770204PMC
February 2018

Examining school-day dietary intakes among Canadian children.

Appl Physiol Nutr Metab 2017 Oct 23;42(10):1064-1072. Epub 2017 Aug 23.

Food, Nutrition, and Health, Faculty of Land and Food Systems, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.

Understanding how dietary intakes vary over the course of the school day can help inform targeted school-based interventions, but little is known about the distribution or determinants of school-day dietary intakes in Canada. This study examined differences between school-hour and non-school-hour dietary intakes and assessed demographic and socioeconomic correlates of school-hour diet quality among Canadian children. Nationally representative data from the Canadian Community Health Survey were analyzed using 24-h dietary recalls falling on school days in 2004 (n = 4827). Differences in nutrient and food-group densities during and outside of school hours and differences in School Heathy Eating Index (School-HEI) scores across sociodemographic characteristics were examined using survey-weighted, linear regression models. Children reported consuming, on average, 746 kcal during school hours (one-third of their daily energy intakes). Vitamins A, D, B, calcium, and dairy products densities were at least 20% lower during school hours compared with non-school hours. Differences in School-HEI scores were poorly explained by sociodemographic factors, although age and province of residence emerged as significant correlates. The school context provides an important opportunity to promote healthy eating, particularly among adolescents who have the poorest school-hour dietary practices. The nutritional profile of foods consumed at school could be potentially improved with increased intake of dairy products, thereby increasing intakes of protein, vitamin A, vitamin D, calcium, and magnesium.
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http://dx.doi.org/10.1139/apnm-2017-0125DOI Listing
October 2017
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