Aligning Environmental Sustainability, Health Outcomes, and Affordability in Diet Quality: A Systematic Review.

Improving diet quality while simultaneously maintaining planetary health is of critical interest globally. Despite the shared motivation, advancement remains slow, and the research community continues to operate in silos, focusing on certain pairings (diet-climate), or with a discipline-specific lens of a sustainable diet, rather than examining their totality. This review aimed to summarize the literature on adherence to a priori defined dietary patterns in consideration of diet quality, metabolic risk factors for noncommunicable diseases (NCDs), environmental impacts, and affordability. A methodology using PRISMA guidelines was followed, and searches were performed in 7 databases as of October 2022. The Appraisal tool for Cross-Sectional Studies (AXIS) and the National Institutes of Health (NIH) quality assessment tool for observational cohort studies were employed for quality appraisal. The evidence was narratively synthesized according to the characteristics of the diet quality metrics. The review includes 24 studies published between 2017-2023. Thirteen distinct diet quality scores were identified, with those measuring adherence to national dietary guidelines the most reported. Thirteen distinct environmental impact indicators were identified, with greenhouse gas emissions (n=23) reported most. All studies reported on body mass index, and 7 studies assessed the cost of adherence. Our results are consistent with previous findings that healthier diets can reduce environmental impacts; however, incongruities between population and planetary health can occur. Hence, the "sustainability" of dietary patterns is dependent on the choice of indicators selected. Further, healthy, lower impact diets can increase financial cost, but may also provide a protective role against the risk of obesity. Given the Global Syndemic, strategies to reduce obesity prevalence should emphasize the win-win opportunities for population and planetary health through dietary change. Research should identify diets that address multiple environmental concerns to curtail burdens potentially transferring, and harmonize this with sociocultural and equity dimensions. This review was registered at PROSPERO as CRD42021238055.

Nutrition strategies to counteract sarcopenia: a focus on protein, LC n-3 PUFA and precision nutrition.

Diminished skeletal muscle strength and size, termed sarcopenia, contributes substantially to physical disability, falls, dependence and reduced quality of life among older people. Physical activity and nutrition are the cornerstones of sarcopenia prevention and treatment. The optimal daily protein intake required to preserve muscle mass and function among older adults is a topic of intense scientific debate. Older adults require protein intakes about 67 % higher than their younger counterparts to maximally stimulate postprandial muscle protein synthesis rates. In addition, evidence suggests a possible benefit of increasing protein intake above the population reference intake (0⋅83 g/kg/d) on lean mass and, when combined with exercise training, muscle strength. In addition to protein quantity, protein quality, the pattern of protein intake over the day and specific amino acids (i.e. leucine) represent key considerations. Long-chain n-3 PUFA (LC n-3 PUFA) supplementation has been shown to enhance muscle protein synthesis rates, increase muscle mass and function and augment adaptations to resistance training in older adults. Yet, these effects are not consistent across all studies. Emerging evidence indicates that an older person's dietary, phenotypic and behavioural characteristics may modulate the efficacy of protein and LC n-3 PUFA interventions for promoting improvements in muscle mass and function, highlighting the potential inadequacy of a 'one-size-fits-all' approach. The application of personalised or precision nutrition to sarcopenia represents an exciting and highly novel field of research with the potential to help resolve inconsistencies in the literature and improve the efficacy of dietary interventions for sarcopenia.

Prevalence and determinants of sarcopenia in community-dwelling older adults in Ireland.

BACKGROUND: Data on the prevalence of sarcopenia among older adults in Ireland are lacking. AIMS: To assess the prevalence and determinants of sarcopenia among community-dwelling older adults in Ireland. METHODS: This cross-sectional analysis involved n = 308 community-dwelling adults aged ≥ 65 y living in Ireland. Participants were recruited via recreational clubs and primary healthcare services. Sarcopenia was defined according to the 2019 European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. Skeletal muscle mass was estimated using bioelectrical impedance analysis, strength was measured via handgrip dynamometry, and physical performance was assessed using the Short Physical Performance Battery. Detailed information was collected on demographics, health, and lifestyle. Dietary macronutrient intake was measured via a single 24 h recall. Binary logistic regression was used to examine potential demographic, health, lifestyle, and dietary determinants of sarcopenia (where both probable and confirmed sarcopenia were combined). RESULTS: The prevalence of EWGSOP2-defined probable sarcopenia was 20.8% and confirmed sarcopenia was 8.1% (5.8% had severe sarcopenia). Polypharmacy (OR 2.60, 95% confidence interval [CI] 1.3, 5.23), height (OR 0.95, 95% CI 0.91, 0.98), and Instrumental Activities Of Daily Living (IADL) score (OR 0.71, 95% CI 0.59, 0.86) were independently associated with sarcopenia (probable and confirmed combined). There were no independent associations between energy-adjusted macronutrient intakes, as determined by 24 h recall, and sarcopenia. CONCLUSION: Sarcopenia prevalence within this sample of community-dwelling older adults in Ireland is broadly similar to other European cohorts. Polypharmacy, lower height, and lower IADL score were independently associated with EWGSOP2-defined sarcopenia.

Plasma lutein and zeaxanthin concentrations associated with musculoskeletal health and incident frailty in The Irish Longitudinal Study on Ageing (TILDA).

INTRODUCTION: Lutein and zeaxanthin are diet-derived carotenoids that are proposed to help mitigate frailty risk and age-related declines in musculoskeletal health via their anti-oxidant and anti-inflammatory properties. Therefore, this study aimed to investigate the association between lutein and zeaxanthin status and indices of musculoskeletal health and incident frailty among community-dwelling adults aged ≥50 years in the Irish Longitudinal Study on Ageing (TILDA). METHODS: Cross-sectional analyses (n = 4513) of plasma lutein and zeaxanthin concentrations and grip strength, usual gait speed, timed up-and-go (TUG), probable sarcopenia (defined as grip strength <27 kg in men, <16 kg in women), and bone mass (assessed using calcaneal broadband ultrasound stiffness index) were performed at Wave 1 (2009-2011; baseline). In the longitudinal analyses (n = 1425-3100), changes in usual gait speed (at Wave 3, 2014-2015), grip strength (Wave 4, 2016) and TUG (at Wave 5, 2018), incident probable sarcopenia (at Wave 4) and incident frailty (Fried's phenotype, Frailty Index, FRAIL Scale, Clinical Frailty Scale-classification tree, at Wave 5) were determined. Data were analysed using linear and ordinal logistic regression, adjusted for confounders. RESULTS: Cross-sectionally, plasma lutein and zeaxanthin concentrations were positively associated with usual gait speed (B [95 % CI] per 100-nmol/L higher concentration: Lutein 0.59 [0.18, 1.00], Zeaxanthin 1.46 [0.37, 2.55] cm/s) and inversely associated with TUG time (Lutein -0.07 [-0.11, -0.03], Zeaxanthin -0.14 [-0.25, -0.04] s; all p < 0.01), but not with grip strength or probable sarcopenia (p > 0.05). Plasma lutein concentration was positively associated with bone stiffness index (0.54 [0.15, 0.93], p < 0.01). Longitudinally, among participants who were non-frail at Wave 1, higher plasma lutein and zeaxanthin concentrations were associated lower odds of progressing to a higher frailty category (e.g. prefrailty or frailty) by Wave 5 (ORs 0.57-0.89, p < 0.05) based on the Fried's phenotype, FRAIL Scale and the Clinical Frailty Scale, and in the case of zeaxanthin, Frailty Index. Neither plasma lutein nor zeaxanthin concentrations were associated with changes in musculoskeletal indices or incident probable sarcopenia (p > 0.05). CONCLUSION: Higher plasma lutein and zeaxanthin concentrations at baseline were associated with a reduced likelihood of incident frailty after ~8 years of follow up. Baseline plasma lutein and zeaxanthin concentrations were also positively associated with several indices of musculoskeletal health cross-sectionally but were not predictive of longitudinal changes in these outcomes over 4-8 years.

Food neophobia and its relationship with dietary variety and quality in Irish adults: Findings from a national cross-sectional study.

Food neophobia is characterised by a reluctance to eat novel or unfamiliar foods and has been linked to reduced dietary variety and quality. However, this link has been primarily studied in children. Therefore, we aimed to explore the relationship between food neophobia and dietary variety and quality in adults using a sub-sample of the National Adults Nutrition Survey collected between 2008 and 2010 (n = 1088). Food and nutrient intakes were assessed using a 4-day semi-weighed food diary. Food neophobia was measured using the Food Neophobia Scale (FNS). Dietary variety was assessed in three ways; Total Dietary Variety (TDV), Food-Group Variety (FGV) and Fruit and Vegetable Variety (FVV). Diet quality was assessed using the Mean Adequacy Ratio (MAR) and Nutrient-Rich Food Index (NRF9.3). A multivariate general linear model was used to assess the linear relationships between FNS score and all dietary measures, controlling for age, sex, education level, social class, location and BMI. Food neophobia was found to be inversely associated with TDV, FGV and FVV. In addition, food neophobia was negatively associated with vitamin C, magnesium and fruit and vegetable intakes and positively associated with percentage energy from free sugars. However, food neophobia was not significantly associated with all other nutrients, MAR and NRF9.3. While these results suggest food neophobia may not be a particularly important risk factor for poor nutrient status, adherence to certain dietary recommendations remains low within the Irish population and food neophobia may further inhibit the adaption of healthy and sustainable diets. Future research should seek to understand the implications of food neophobia on dietary behaviour change.

Does supplementation with leucine-enriched protein alone and in combination with fish-oil-derived n-3 PUFA affect muscle mass, strength, physical performance, and muscle protein synthesis in well-nourished older adults? A randomized, double-blind, placebo-controlled trial.

BACKGROUND: Leucine-enriched protein (LEU-PRO) and long-chain (LC) n-3 (ω-3) PUFAs have each been proposed to improve muscle mass and function in older adults, whereas their combination may be more effective than either alone. OBJECTIVE: The impact of LEU-PRO supplementation alone and combined with LC n-3 PUFAs on appendicular lean mass, strength, physical performance and myofibrillar protein synthesis (MyoPS) was investigated in older adults at risk of sarcopenia. METHODS: This 24-wk, 3-arm parallel, randomized, double-blind, placebo-controlled trial was conducted in 107 men and women aged ≥65 y with low muscle mass and/or strength. Twice daily, participants consumed a supplement containing either LEU-PRO (3 g leucine, 10 g protein; n = 38), LEU-PRO plus LC n-3 PUFAs (0.8 g EPA, 1.1 g DHA; LEU-PRO+n-3; n = 38), or an isoenergetic control (CON; n = 31). Appendicular lean mass, handgrip strength, leg strength, physical performance, and circulating metabolic and renal function markers were measured pre-, mid-, and postintervention. Integrated rates of MyoPS were assessed in a subcohort (n = 28). RESULTS: Neither LEU-PRO nor LEU-PRO+n-3 supplementation affected appendicular lean mass, handgrip strength, knee extension strength, physical performance or MyoPS. However, isometric knee flexion peak torque (treatment effect: -7.1 Nm; 95% CI: -12.5, -1.8 Nm; P < 0.01) was lower postsupplementation in LEU-PRO+n-3 compared with CON. Serum triacylglycerol and total adiponectin concentrations were lower, and HOMA-IR was higher, in LEU-PRO+n-3 compared with CON postsupplementation (all P < 0.05). Estimated glomerular filtration rate was higher and cystatin c was lower in LEU-PRO and LEU-PRO+n-3 postsupplementation compared with CON (all P < 0.05). CONCLUSIONS: Contrary to our hypothesis, we did not observe a beneficial effect of LEU-PRO supplementation alone or combined with LC n-3 PUFA supplementation on appendicular lean mass, strength, physical performance or MyoPS in older adults at risk of sarcopenia. This trial was registered at clinicaltrials.gov as NCT03429491.

The role of meat in strategies to achieve a sustainable diet lower in greenhouse gas emissions: A review.

Food consumption is responsible for a considerable proportion of greenhouse gas emissions (GHGE). Hence, individual food choices have the potential to substantially influence both public health and the environment. Meat and animal products are relatively high in GHGE and therefore targeted in efforts to reduce dietary emissions. This review first highlights the complexities regarding sustainability in terms of meat consumption and thereafter discusses possible strategies that could be implemented to mitigate its climatic impact. It outlines how sustainable diets are possible without the elimination of meat. For instance, overconsumption of food in general, beyond our nutritional requirements, was found to be a significant contributor of emissions. Non-voluntary and voluntary mitigation strategies offer potential to reduce dietary GHGE. All mitigation strategies require careful consideration but on-farm sustainable intensification perhaps offers the most promise. However, a balance between supply and demand approaches is encouraged. Health should remain the overarching principle for policies and strategies concerned with shifting consumer behaviour towards sustainable diets.

Mitigating Nutrition and Health Deficiencies in Older Adults: A Role for Food Innovation?

The aim of this review is to describe the factors contributing to diminished food intake, resulting in nutritional deficiencies and associated health conditions in older adults and proposes food innovation strategies to mitigate these. Research has provided convincing evidence of a link between healthy eating patterns and healthy aging. There is a need to target new food product development (NPD) with functional health benefits specifically designed to address the particular food-related needs of older consumers. When developing foods for older adults, consideration should be given to the increased requirements for specific macro- and micronutrients, especially protein, calcium, vitamin D, and vitamin B. Changes in chemosensory acuity, chewing difficulties, and reduced or poor swallowing ability should also be considered. To compensate for the diminished appetite and reduced intake, foods should be energy dense, nutritionally adequate, and, most importantly, palatable, when targeting this cohort. This paper describes the potential of new food product development to facilitate dietary modification and address health deficiencies in older adults.

The climatic impact of food consumption in a representative sample of Irish adults and implications for food and nutrition policy.

OBJECTIVE: To evaluate the greenhouse gas emissions (GHGE) associated with the diet of Irish adults. DESIGN: GHGE were estimated by applying conversion factors to habitual food consumption data taken from the National Adult Nutrition Survey, which was representative of the population. Descriptive analyses were undertaken for GHGE for the total population, as well as accounting for energy misreporting and across categories of sociodemographic and socio-economic factors and tertiles of emissions. SETTING: Republic of Ireland. SUBJECTS: Adults aged 18-87 years (n 1500). RESULTS: The GHGE derived from daily dietary intakes was estimated as 6·5 kg of CO2 equivalents (CO2eq) per person. Males, younger consumers, those with secondary education and student employment status were associated with significantly higher GHGE. Red meat was the highest contributor to GHGE with 1646 g CO2eq arising from a mean intake of 47 g/d. Dairy and starchy staples were the next largest dietary GHGE sources, with mean daily emissions of 732 g CO2eq and 647 g CO2eq, respectively. The lowest emissions were associated with consumption of vegetables, fruits and legumes/pulses/nuts. CONCLUSIONS: Based on profiling using actual food consumption data, it is evident that one single measure is not sufficient and a range of evidence-based mitigation measures with potential to lower emissions throughout the food chain should be considered. The research contributes towards an improved understanding of the climatic impact of the dietary intakes of Irish adults and can serve to inform a sustainability framework to guide action in food and nutrition policy development.

The creation of a healthy eating motivation score and its association with food choice and physical activity in a cross sectional sample of Irish adults.

BACKGROUND: This study aimed to develop a healthy eating motivation score and to determine if dietary, lifestyle and activity behaviours vary across levels of motivation to eat a healthy diet with a view to informing health promotion interventions. METHODS: A cross-sectional survey of food intake, physical activity, lifestyles and food choice attitudes was conducted in a nationally representative sample of 1262 adults in the Republic of Ireland aged 18 years and over. RESULTS: Increasing score for health motivation was significantly and positively related to healthy eating and exercise. Women, increasing age, normal BMI, regular exercise and increasing intakes of fruit and vegetables were associated with a higher odds ratio (OR) for having a high healthy eating motivation score. However, despite a high motivation score only 31% of consumers in the strong motivation group achieved the recommendations for daily fruit and vegetable consumption, while 57% achieved the fat recommendation. A higher intake of calorie dense foods from the top shelf of the food pyramid and increased time spent watching T.V. was associated with a decreased OR for positive motivation towards healthy eating. CONCLUSIONS: Healthy eating promotions directed at women and older adults should focus on supporting people's motivations to attain a healthy diet by addressing issues such as dietary self-control and self-regulation. For men and younger adults, healthy eating promotions will need to address the issues underlying their weak attitudes towards healthy eating.

Complexity and conundrums. Citizens' evaluations of potentially contentious novel food technologies using a deliberative discourse approach.

This research considers the processes involved in the formation of attitudes by citizens on potentially contentious novel food technologies (NFTs). Observations of one-to-one deliberative discourses between food scientists and citizens, during which they discussed these technologies, form the basis of this enquiry. This approach enables an exploration of how individuals construct meaning around as well as interpret information about the technologies. Thematic analysis identifies key features that provide the frameworks for citizens' evaluations. How individuals make sense of these technologies is shaped by their beliefs, values and personal characteristics; their perceptions of power and control over the development and sale of NFT related products; and, the extent to which these products are relevant to their personal lives. Internal negotiations between these influences are evident, and evaluations are based on the relative importance of each influence to the individual. Internal conflicts and tensions are associated with citizens' evolving evaluative processes, which may in turn present as attitude ambivalence and instability. Many challenges are linked with engaging with the general public about these technologies, as levels of knowledge, understanding and interest vary.

"Eat like a man". A social constructionist analysis of the role of food in men's lives.

This paper adopts a social constructionist approach to investigate the role of food in the production of identities and social experiences for men. With recognition that relational and experiential processes are central to men's lives, the purpose of the paper is to inductively explore the personal and interpersonal complexities of this group's food related behaviours. Empirical data were collected through a series of semi-structured interviews with 33 men, comprising of 4 age groups, (18-35, 36-54, 55-64, and 65+ years). Regardless of age, an analysis and interpretation yielded three emergent themes, food as a component of: (1) role-play; (2) contextual interactions, (3) and the management of a functional vs. hedonic dialectic. Across these themes various tensions and contradictions emerged suggesting a complex reflexivity to male food life experiences. Relational issues emerged such as the observation that some men concede control to their partners throughout their food experiences. Overall, our men's consumption practices construct a specific socio-cultural articulation of masculine roles whereby their internal paradoxes are leveraged as a means to produce desirable experiences and self-identifications.

Intakes of total fat, saturated, monounsaturated and polyunsaturated fatty acids in Irish children, teenagers and adults.

Recommendations limiting the intake of total fat, SFA, MUFA and PUFA have been established in several countries with the aim of reducing the risk of chronic diseases such as CVD. Studies have shown that intakes of total fat and SFA are above desired recommended intake levels across a wide range of age and sex groups. In addition, intakes of PUFA and MUFA are often reported to be less than the desired recommended intake levels. The aims of the present paper are to provide the first data on estimates of current intakes and main food sources of SFA, MUFA and PUFA in Irish children (aged 5-12 years), teenagers (aged 13-17 years) and adults (aged 18-64 years) and to analyse compliance with current dietary recommendations. Data for this analysis were based on the North/South Ireland Food Consumption Survey (n 1379, 18-64 years), the National Children's Food Survey (n 594, 5-12 years) and the National Teen Food Survey (n 441, 13-17 years). Results showed that SFA intakes in Irish children, teenagers and adults are high, with only 6 % of children, 11 % of teenagers and 21 % of adults in compliance with the recommended daily intake. The main food groups that contributed to SFA intakes were whole milk; fresh meat; meat products; biscuits, cakes, buns and pastries; and sugars, confectionery and preserves.

Relationship between energy from added sugars and frequency of added sugars intake in Irish children, teenagers and adults.

A WHO report on diet, nutrition and the prevention of chronic diseases recommended that frequency of consumption of foods and/or drinks containing free sugars should be limited to a maximum of four times per d. In addition, they recommended a reduction in the intake of free sugars to a maximum of no more than 10 % of energy intake. These recommendations were developed with the aim of reducing the prevalence of dental caries. The aim of the present study was to establish if there is a quantitative relationship between energy from added sugars and frequency of added sugars intakes in Irish children, teenagers and adults. In addition, the intake of added and total sugars and main contributors to added sugar intakes were examined. Data for the present analysis were based on the North/South Ireland Food Consumption Survey (n 1379; aged 18-64 years), the National Children's Food Survey (n 594; aged 5-12 years) and the National Teen Food Survey (n 441; aged 13-17 years) which used 7 d food diaries to collect food and beverage intake data in representative samples of Irish adults, children and teenagers respectively. Results showed that in adults, frequency of intake of added sugar intake of four times per d corresponded to a mean added sugar intake of 9 %, which was similar to the WHO recommendation. In children and teenagers, a frequency of intake of four times per d corresponded to a mean added sugar intake of 14.6 and 12.4 % respectively and was therefore not in agreement with the WHO recommendation.

A new reference method for the validation of the nutrient profiling schemes using dietary surveys.

Nutrient profiles of foods are increasingly used as the scientific basis of nutritional labeling, health claims, or nutritional education. Nutrient profiling schemes are based on sets of rules, scores, or thresholds applied to the nutritional composition of foods. However, there is a lack of scientific validation of nutritional profiling schemes. To develop a reference method using existing dietary surveys, to define a set of indicator foods that are positively or negatively associated with a "healthy diet." Such indicator foods can be used both for establishing relevant nutrient profiles and for the validation of existing or future nutrient profiling schemes. The proposed validation method is based on food and nutrient intakes of adults participating in national dietary surveys in five EU countries: Belgium (n = 2,507), Denmark (n = 3,151), France (n = 1,474), Ireland (n = 1,379), and Italy (n = 1,513). The characterization of indicator foods is divided in two steps. First, "healthy diets" of individuals are identified in the five national dietary surveys by comparison to the Eurodiet reference intakes. Second, indicator foods associated positively or negatively to the "healthy diets" are determined. With a P-value of 10(-3) for the test of comparison of food intakes between the "most healthy eaters" and the "less healthy eaters," it was possible to identify 294 indicator foods out of 1,669 foods tested in the five countries. In all the countries except Italy, there were more indicator foods positively associated than indicator foods negatively associated with the "healthy diet." The food categories of these indicator foods were in good agreement with Food Based Dietary Guidelines like the USDA dietary guideline for Americans. A new reference method for the validation of profiling schemes was developed based on dietary intake data from using dietary surveys in five European countries. Only a minority of foods consumed in these dietary surveys could be used as indicator foods of healthy or unhealthy diets in order to subsequently test nutritional profiling schemes. Further work is needed to build a list of indicator foods that could be considered as a "gold standard."

Comparison of different nutrient profiling schemes to a new reference method using dietary surveys.

A new EU regulation on nutrition and health claims made on foods has entered into force in January 2007. The regulation provides for the use of nutrient profiles to determine which foods may bear claims but does not specify what the profiles should be or how they should be developed. Several nutrient profiling schemes have already been established. Therefore, it is necessary to develop approaches to test if the existing profiling schemes could fulfil the new regulation needs. The aim of the present study is to investigate how reference "indicator foods" derived from national dietary surveys in five different countries, are classified according to three existing nutrient profiling schemes: The UK Food Standards Agency (FSA) model, The Dutch Tripartite classification model and the US FDA model used for regulating health claims. "Indicator foods" that have been shown to be positively or negatively associated with healthy diets in adults in five EU countries were classified according to each of the three profiling schemes. The performance and effectiveness of each profiling scheme in correctly classifying the "indicator foods" were assessed using sensitivity and specificity ratios. The sensitivity and the specificity ratios of the three profiling schemes tested were relatively good. There were only small differences of performance between the three systems. A significant negative correlation between sensitivity and specificity was observed. The level of concordance between the classification of the "indicator foods" that have been selected because of being positively or negatively associated with a healthy diet and the classification by each of the three profiling methods tested was quite good. However, further improvement of the "indicator foods" approach is needed if it is to serve as a "gold standard".

Approaches to assessment of exposure to food- and supplement-derived amino acids.

Although the amino acid composition of almost all food proteins is known, estimating the amino acid intake from the diet is extremely difficult because of the lack of available data. A conservative approach would be to determine the population distribution of protein intake, select the 97.5(th) or higher percentile of intake, assume all comes from the target protein, and estimate exposure to some specific amino acid. Any number of dietary survey methodologies could be used to conduct such a conservative approach. However, given the great variety of brands of food supplements, estimates of amino acid intakes from supplements are problematic. Firstly, few studies include supplements in their target nutrient sources because brand-level data would need to be retained and nutritional composition data would need to be recorded. Probabilistic modeling offers some solution provided some basic data are gathered. The percentage of the population regularly taking supplements and the frequency of consumption must be known. Therefore, data on the dietary supplement market would need to be known including the percent of brands containing amino acids and if possible specific amino acids together with concentrations. A probabilistic model as follows would ensue: probability of being a consumer of amino acid supplements; probability distribution function of frequency of use of supplements; probability distribution function of dose per eating occasion; market characteristics; probability distribution function for dietary amino acid intake. Using multiple iterations and perhaps bootstrapping on some elements of the model, fully worst-case model scenarios of exposure could be computed.