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The therapeutic effects of probiotics in patients with traumatic brain injury (TBI) remain unclear. This study aimed to investigate the effects of probiotic supplementation on cell adhesion molecules (CAMs), oxidative stress and antioxidant parameters in TBI patients. This randomised, double-blind, placebo-controlled trial included forty-six TBI patients who were randomly assigned to receive either a probiotic supplement (n 23) or a placebo (n 23) for 14 d. The probiotic capsule contained four strains of Lactobacillus (L. casei, L. bulgaricus, L. rhamnosus, L. acidophilus), two strains of Bifidobacterium (B. longum, B. breve) and Streptococcus thermophilus. Serum levels of intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1, pro-oxidant–antioxidant balance (PAB), malondialdehyde (MDA), nitric oxide (NO), total antioxidant capacity (TAC) and arylesterase (ARE) activity were measured at the beginning and end of the trial. Dietary intakes of patients were also recorded at the beginning and end of the trial. At the end of the study, there were no significant changes in ICAM-1, VCAM-1, PAB, MDA, NO, TAC and ARE levels. However, patients who received probiotic supplements had significantly increased dietary intakes of energy, macronutrients, vitamin E, Zn, Cu and Se compared with the placebo group. This study provides evidence that probiotic supplementation for 14 d in TBI patients has beneficial effects on dietary intake. However, it did not affect serum levels of CAMs, oxidative stress or antioxidant parameters. These findings should be considered preliminary, and further research is needed to evaluate long-term and clinical outcomes.
Foods are frequently marketed to children through the inclusion of a wide range of elements on the packages. Several studies conducted in different countries around the globe have shown that products marketed to children are usually high in sugar and other nutrients associated with non-communicable diseases. The present exploratory cross-sectional study aimed at providing additional evidence on the composition of products marketed to children by analysing the disclosure of additives in such products. Data were collected at nine supermarkets in two Uruguayan cities between August and October 2021. All packaged products available in each supermarket were surveyed using a cell phone app, except for culinary ingredients. All the information from the labels was extracted. Products marketed to children were identified based on the presence of indicators of child-directed marketing on the package. The disclosure of additives was analysed based on the information available in the ingredient list. The prevalence of food additive disclosure was calculated. Of the 7,343 products included in the database, 573 (7.8%) were classified as marketed to children. Candies and cookies were the categories with the largest number of products marketed to children. The great majority of the products marketed to children disclosed at least one food additive (93.5%). These products tended to more frequently notify colourings, antioxidants, acidity regulators, raising agents, stabilisers, humectants, anticaking agents, and glazing agents compared to products not marketed to children. These findings underscore the need to expand the current scope of regulations on marketing targeted at children beyond nutrients to include additives potentially linked to adverse health effects, such as artificial colourings.
This study aimed to investigate the impact of Astragalus dregs — the residue after the extraction of principal active components — on the growth performance, antioxidant capacity, and immune function of fattening pigs. Twenty-four 130 days of age fattening pigs were randomly assigned to the control group and experimental group (supplemented with 10% Astragalus dregs). The production performance was evaluated by average daily gain (ADG), average daily feed intake (ADFI) and diarrhoea rates. Additionally, nutrient digestibility, blood biochemical parameters, antioxidant capacity, and immune function factors were analysed. The group supplemented with Astragalus dregs showed a trend towards improved ADG and ADFI and reduced diarrhoea rates (p > 0.05). Moreover, it significantly enhanced the digestibility of dry matter, crude protein, and ether extract (p < 0.05). Blood analysis revealed that globulin and total protein were increased, and glucose, cholesterol and triglyceride levels were decreased (p < 0.05) in the group supplemented with Astragalus dregs. The antioxidant capacity was significantly promoted by elevated T-AOC, GSH-px, and SOD activities and reduced malondialdehyde levels (p < 0.05). The immune function factors demonstrated that IgA, IgG, IgM, and anti-inflammatory cytokines IL-10 and IL-22 were significantly increased, meanwhile pro-inflammatory cytokines IL-2 and IL-6 were decreased (p < 0.05).
These findings indicate that Astragalus dregs, as a dietary supplement, may enhance growth performance, antioxidant capacity and immune function in fattening pigs. It is suggested that future studies should explore the optimal supplementation ratio of Astragalus dregs in pig diets.
We have used multiple regression analyses to develop a series of metabolisable energy prediction equations from chemical analyses of pig diets that can be extended to murine diets. We compiled four datasets from an extensive range of published metabolism studies with grower/finisher and adult pigs. The analytes in the datasets were increasingly complex, comprising (1) the proximate or Weende analysis, (2) the previous analysis but with neutral detergent fibre replacing crude fibre, (3) the neutral detergent fibre package plus starch and (4) the neutral detergent fibre package plus starch and sugars. Diet manufacturers routinely provide most of the analytes for batches of murine diet, or they are easily obtainable. The study uniquely compares the four analytical packages side by side. The number of records in the datasets varies from 367 to 827. With increasing analytical complexity, adjusted R2 values for metabolisable energy prediction improved from 0·751 to 0·869 and the mean absolute error from 0·422 to 0·289 kJ/g. Overall, the models’ prediction interval improved from 1 to 0·7 kJ/g, which is ± 7 to 5 % for a typical dietary metabolisable energy density of 14·8 kJ/g. Although prediction accuracy increases as one extends the range and complexity of the analytes measured, the improvement is slight and may not justify the substantial increase in analytical cost. The equations were validated for use on future datasets by k-fold analysis. Although the equations are developed from pig data, they are suitable for rat and mouse diets, based on comparable digestibility measurements, and substantially improve existing methods.
Although research on the relationship between lean body mass and blood pressure (BP) has been inconsistent, most studies reported that measures of lean body mass are associated with a higher risk of hypertension. We explored relationships between body composition (fat and skeletal muscle mass) and BP in 1162 young adult African women. Dual-energy X-ray absorptiometry-derived measures of whole-body, central and arm fat mass were associated with higher systolic and diastolic BP, while leg fat percentage was associated with lower systolic and diastolic BP. However, only the associations with diastolic BP remained after adjusting for appendicular skeletal muscle mass (ASM). ASM was associated with higher systolic and diastolic BP, before and after adjusting for whole-body fat percentage and visceral adipose tissue. While there was no overlap in targeted proteomics of BP and body composition, REN was lower in the elevated BP than the normal BP group and was inversely associated with diastolic BP (false rate discovery adjusted P< 0·050). Several proteins were positively associated with both visceral adipose tissue and ASM (LEP, FABP4, IL6 and GGH) and negatively associated with both visceral adipose tissue and ASM (ACAN, CELA3A, PLA2G1B and NCAM1). NOTCH3, ART3, COL1A1, DKK3, ENG, NPTXR, AMY2B and CNTN1 were associated with lower visceral adipose tissue only, and IGFBP1 was associated with lower ASM only. While the associations between body fat and BP were not independent of skeletal muscle mass, the associations between muscle mass and BP were independent of overall and central adiposity in young adult African women. Future interventions targeting muscle mass should also monitor BP in this population.
Adherence to healthy diet principles and to cardiopreventive medication, both key behaviours in CVD prevention, is known to differ between women and men. Whether these adherence behaviours are differentially related among women and men has never been thoroughly assessed. The objective was to assess gender differences in the association between adherence to healthy diet principles and to cardiopreventive medication in adults free of CVD. This cross-sectional study included 268 women and 204 men from the CARTaGENE cohort (Québec, Canada) who were using antihypertensive and/or cholesterol-lowering medication. Adherence to healthy diet principles was assessed using the Alternate Healthy Eating Index (AHEI, %), calculated from a validated FFQ assessing diet in the 12-month preceding its completion. Medication adherence was assessed using the daily pharmacotherapy possession rate (DPPR, %), calculated from prescription claim data over the same 12-month period. In multivariable-adjusted analyses, an inverse association between AHEI and DPPR was observed among men (βAHEI for 10 % increment in DPPR = –0·65 %; 95 % CI −1·28 %, −0·03 %; P = 0·04), while it tended to be positive among women (β = 0·44 %; 95 % CI −0·11 %, 1·00 %; P = 0·12; Pgender×DPPR = 0·01). The negative association between AHEI and DPPR was stronger among men who never smoked or used cholesterol-lowering medication only. Among women, the positive association was stronger and statistically significant among those with obesity or using ≥ 3 medications simultaneously. Association between adherence to healthy diet principles and to cardiopreventive medication differs between women and men, with men potentially facing greater challenges in achieving optimal complementarity between these two behaviours.
Anaemia remains a significant public health concern in developing countries. This study estimated the proportion of childhood anaemia cases that could be potentially prevented in Togo using data from the 2017 National Malaria Indicator Survey. Maternal, child, and household data were collected through standardized face-to-face interviews. Haemoglobin (Hb) levels were measured in children and their mothers. A total of 2796 children were included in the analyses. The prevalence of anaemia was 75·0 % (95 % CI, CI: 72·5, 88·0). Factors associated with childhood anaemia were age ((adjusted prevalence ratio, aPR = 1·46 (CI: 1·37, 1·56) for 6–23 months and aPR = 1·23 (1·14, 1·32) for 24–42 months, ref: 43–59 months), a later birth order (≥ 4th position) (aPR = 1·11 (1·03, 1·19), ref: 1st–2nd position), malaria in children (aPR = 1·30 (1·22, 1·38)), maternal age ≤ 25 (aPR = 1·17 (1·08, 1·27), ref: ≥ 35 years), maternal anaemia (aPR = 1·13 (1·07, 1·19)), lack of maternal education (aPR = 1·10 (1·02, 1·18), ref: ≥ secondary), number of children under 5 in household (aPR = 1·07 (1·00, 1·14) for ≥ 3, ref: 0–1), unimproved sanitation facilities (aPR = 1·12 (1·02, 1·22)) and low/middle household incomes (aPR = 1·16 (1·04, 1·30) and aPR = 1·13 (1·01, 1·26), respectively, ref: high). The population-attributable fraction was estimated at 8·2 % (6·3, 10·1 %) for child-related modifiable factors, 11·1 % (5·7, 16·3 %) for maternal-related factors, 15·8 % (8·6, 22·5 %) for household-related factors and 30·9 % (24·0, 37·2 %) for the combination of all modifiable factors. This study highlighted a high prevalence of childhood anaemia in Togo and showed that a high proportion of this could be prevented.
This cross-sectional ecological study described fruit and vegetable (F&V) intake variability across 144 cities in 8 Latin American countries and by city-level contextual variables. Data sources came from health surveys and census data (Argentina, Brazil, Chile, Colombia, El Salvador, Guatemala, Mexico, and Peru). Self-reported frequency of F&V intake was harmonised across surveys. Daily F&V intake was considered as consumption 7 d of the week. Using a mixed-effects model, we estimated age and sex-standardised city prevalences of daily F&V intake. Through Kruskal–Wallis tests, we compared city F&V daily intake prevalence by tertiles of city variables related to women’s empowerment, socio-economics, and climate zones. The median prevalence for daily F&V intake was 55.7% across all cities (22.1% to 85.4%). Compared to the least favourable tertile of city conditions, F&V daily intake prevalence was higher for cities within the most favourable tertile of per capita GDP (median = 65.7% vs. 53.0%), labour force participation (median = 68.7% vs. 49.4%), women achievement-labour force score (median = 63.9% vs. 45.7%), and gender inequality index (median = 58.6% vs. 48.6%). Also, prevalences were higher for temperate climate zones than arid climate zones (median = 65.9% vs. 50.6%). No patterns were found by city level of educational attainment, city size, or population density. This study provides evidence that the prevalence of daily F&V intake varies across Latin American cities and may be favoured by higher socio-economic development, women’s empowerment, and temperate weather. Interventions to improve F&V intake in Latin America should consider the behaviour disparities related to underlying local social, economic, and climate zone characteristics.
To develop and evaluate the validity and reliability of the Street Food and Beverage Tool (SFBT).
Design:
This methodological study contains two phases: (a) tool development, which involves conducting a systematic review followed by expert evaluation of the items, the creation of a nutritional healthfulness index (NH), and pilot testing; and (b) evaluation of the Tool’s Validity and Reliability. Content validity was judged by an external technical group, which evaluated the adequacy and pertinence of each tool item. Construct validity was evaluated around schools by testing the hypothesis: In high-income areas, there will be greater availability of healthy food and beverages at street food outlets (SFO), as measured by the NH index. Inter-rater and test–retest reliabilities were assessed outside subway stations. Pearson’s correlation, Cohen’s kappa and Content validity Indexes were used for reliability and validation. A multinomial regression model was used to estimate construct validity.
Setting:
Mexico City, Mexico.
Participants:
80 SFO at subway station exits and 1066 around schools from diverse income areas.
Results:
The SFBT content validity index was satisfactory. The construct validity of the NH index indicated higher values in higher-Social Development Index areas. The NH index showed a positive linear correlation between raters and across the first and second evaluations. The majority of item availability (>60 %) showed moderate to strong kappa values for inter-rater and test–retest reliability.
Conclusions:
The SFBT is a reliable and valid tool for assessing the availability of foods and beverages. Compared to other tools, it can measure the nutritional quality of SFO expressed as an NH index.
Increased ultra-processed food (UPF) is associated with adverse health outcomes. However, with limitations in UPF evidence, and partial overlap between UK front-of-package labelling (FOPL) and degree of food processing, the value of food processing within dietary guidance is unclear. This study compared food and drink from the UK National Diet and Nutrition Survey (NDNS) database based on micronutrient content, Nova classification and FOPL. The aim was to examine the micronutrient contributions of UK food and drink to UK government dietary micronutrient recommendations for adult females and males, aged 19–64 years, based on the degree of food processing and FOPL. NDNS items were coded into minimally processed food (MPF), processed culinary ingredients, processed food (PF) and UPF, and FOPL traffic lights. MPF, PF and UPF provided similar average contributions per 100 g to micronutrient recommendations. Per 100 kcal, MPF provided the greatest average contribution (14·4 % (interquartile range (IQR): 8·2–28·1)), followed by PF (7·7 % (IQR: 4·6–10·9) and then UPF (5·8 % (IQR: 3·1–9·7)). After adjusting for healthy/unhealthy items (presence of 1+ red FOPL), MPF had higher odds of an above-average micronutrient contribution per 100 kcal than UPF (OR: 5·9 (95 % CI 4·9–7·2)) and PF (OR: 3·2 (95 % CI 2·4–4·2)). MPF were more likely to provide greater contributions to micronutrient recommendations than PF or UPF per 100 kcal. These findings suggest that UPF or PF diets are less likely to meet micronutrient recommendations than an energy-matched MPF diet. The results are important for understanding how consumers perceive the healthiness of products based on FOPL.
Explore the relationship between water insecurity (WI) and food security and their covariates in Mexican households.
Design:
A cross-sectional study with nationally representative data from the National Health and Nutrition Survey-Continuous 2021 (in Spanish, ENSANUT-Continua 2021), collected data from 12 619 households.
Setting:
WI was measured using the Household Water Insecurity Experiences (HWISE) Scale in Spanish and adapted to the Mexican context. Food security was measured using the Latin American and Caribbean Food Security Scale. A generalised path model was used to produce two simultaneous logistical regression equations – WI (HWISE ≥ 12) and moderate-to-severe food insecurity (FI) – to understand key covariates as well as the contribution of WI to FI.
Participants:
The head of the household, an adult of >18 years of age, consented to participate in the survey.
Results:
Households experiencing WI were more likely to experience moderate-to-severe FI (OR = 2·35; 95 % CI: 2·02, 2·72). The odds of WI were lower in households with medium (OR = 0·74; 95 % CI: 0·61, 0·9) to high (OR = 0·45; 95 % CI: 0·37, 0·55) asset scores. WI also depended on the region of Mexico. FI is more prevalent in indigenous people (OR = 1·29; 95 % CI: 1·05, 1·59) and rural households (OR = 0·42; 95 % CI: 1·16, 1·73). Notably, wealth and household size did not contribute directly to FI but did so indirectly through the mediating factor of WI.
Conclusions:
Our study shows that there are structural factors that form part of the varied determinants of WI, which in turn is closely linked to FI.
The potential influence of the timing of eating on body weight regulation in humans has attracted substantial research interest. This review aims to critically evaluate the evidence on timed eating for weight loss, considering energetic and behavioural components of the timing of eating in humans. It has been hypothesised that timed eating interventions may alter energy balance in favour of weight loss by enhancing energy expenditure, specifically the thermic effect of food. This energetic effect has been suggested to explain greater weight loss which has been observed with certain timed eating interventions, despite comparable self-reported energy intakes to control diets. However, timed eating interventions have little impact on total daily energy expenditure, and the apparent effect of time of day on the thermic effect of food largely represents an artefact of measurement methods that fail to account for underlying circadian variation in RMR. Differences in weight loss observed in free-living interventions are more likely explainable by real differences in energy intake, notwithstanding similar self-reported energy intakes. In addition, the energetic focus tends to overlook the role of behavioural factors influencing the timing of eating, such as appetite regulation chronotype-environment interactions, which may influence energy intake under free-living conditions. Overall, there is scant evidence that timed eating interventions are superior to general energy restriction for weight loss in humans. However, the role of behavioural factors in influencing energy intake may be relevant for adherence to energy-restricted diets, and this aspect remains understudied in human intervention trials.
Tea intake has been associated with health benefits, including potential beneficial effects of catechin-containing teas on allergic symptoms. However, large-scale epidemiological studies on the relationship between tea intake and allergic symptoms have been limited. The present study aimed to examine the relationship between the frequency of tea intake and cedar pollen allergy, which is a major cause of seasonal hay fever in Japan, in a large Japanese epidemiological cohort. Data on cedar pollen antibody levels assessed by blood tests and frequency of tea intake (green tea, coarse tea, oolong tea, and black tea) by a self-administered questionnaire from 16,623 residents in the Tohoku region of Japan were used in this study. The association between frequency of tea intake (less than once a week, 1–6 times/week, and more than once a day) and serum levels of cedar pollen-specific IgE (lumicount, LC: negative, 0–1.39; positive, ≥1.40) was analysed using a logistic regression model. Green tea intake (≥vs. <1/day) was inversely associated with cedar pollen-specific IgE (adjusted OR = 0.81, 95% CI, 0.70, 0.94). No statistically significant association between cedar pollen-specific IgE and frequency of tea intake was found for other types of tea. Our results suggest that green tea intake may be associated with lower cedar pollen-specific IgE positivity.
This review aims to highlight the relative importance of cardiovascular disease (CVD) lifestyle-associated risk factors among individuals with inflammatory bowel disease (IBD) and examine the effectiveness of lifestyle interventions to improve these CVD risk factors. Adults with IBD are at higher risk of CVD due to systemic and gut inflammation. Besides that, tobacco smoking, dyslipidaemia, hypertension, obesity, physical inactivity and poor diet can also increase CVD risk. Typical IBD behavioural modification including food avoidance and reduced physical activity, as well as frequent corticosteroid use, can further increase CVD risk. We reviewed seven studies and found that there is insufficient evidence to conclude the effects of diet and/or physical activity interventions on CVD risk outcomes among populations with IBD. However, the limited findings suggest that people with IBD can adhere to a healthy diet or Mediterranean diet (for which there is most evidence) and safely participate in moderately intense aerobic and resistance training to potentially improve anthropometric risk factors. This review highlights the need for more robust controlled trials with larger sample sizes to assess and confirm the effects of lifestyle interventions to mitigate modifiable CVD risk factors among the IBD population.
To design and develop a new, innovative and valid School Menu Healthiness Assessment Tool that is suitable for the quantitative and qualitative analysis of school food and drink provision. Second, to analyse primary and secondary school menus and price lists pan-Wales to ascertain their healthiness and whether free school meal (FSM) eligible pupils can afford to access healthy, nutritious food across the school day.
Design:
Codable items and categories of school food and drink provision were operationalised before the tool underwent iterative development and testing. Then, cross-sectional content analysis of publicly available documents detailing school food provision (i.e. menus and price lists) was done.
Setting:
Primary and secondary schools in Wales, UK.
Participants:
In total, 82 canteen menus were sourced online. This comprised local authority catering for primary (n 22) and secondary (n 19) schools and school-organised catering for primary (n 5) and secondary (n 36) schools.
Results:
Intercoder reliability testing found high agreeability between coders, demonstrating that the tool and data interpretation are reproducible and trustworthy. The FSM allowance is not wholly sufficient for all secondary school pupils to purchase a healthy meal from the school canteen. Moreover, the tool identified that oily fish and wholegrain provision were lacking across many menus.
Conclusions:
A valuable tool was created, useful for researchers and other health professionals (i.e. dietitians) who are required to analyse the healthiness of school food provision in line with the latest nutritional requirements. This study provides insight into the current school food and drink landscape pan-Wales.
This interventional single-centre prospective open-label study aims to evaluate the effects of a vegan diet, compared with a vegetarian and omnivorous diet, on metabolic parameters, insulin sensitivity, and liver and kidney steatosis in healthy adults. The study included fifty-three omnivorous participants aged 18–40 years, BMI 18–30 kg/m2, without any chronic disease, chronic medication use, active smoking or significant alcohol consumption. All participants were omnivorous at baseline and selected to continue an omnivorous diet or transition to a vegetarian or vegan diet, with follow-up over 6 months. Anthropometric measurements, biochemical parameters and liver and kidney steatosis were assessed at baseline and after six months using MRI-proton density fat fraction. Primary outcomes included changes in liver and kidney steatosis, while secondary outcomes were alterations in anthropometric and biochemical markers. Among fifty-three participants, eighteen followed an omnivorous diet, twenty-one adopted a vegetarian diet and fourteen transitioned to a vegan diet. Dietary interventions did not result in statistically significant changes in BMI, fat mass, fat percentage or muscle mass over 6 months. However, statistically significant improvements in systolic and diastolic blood pressure, favouring the vegan diet, were observed. We aimed to control for potentially confounding variables to ensure the reliability of these findings. We have demonstrated a better decline in steatosis at the lower kidney pole, the total hilus and the Liver 6 index in vegans. We demonstrated that a plant-based diet is associated with improvements in several metabolic parameters and may reduce liver and kidney steatosis.