Modelling the public health benefits of fibre fortification in the Chinese population through food reformulation.

OBJECTIVES: Various studies have highlighted how consuming adequate dietary fibre (DF) foods could confer multiple potential health benefits to humans, though data suggested that the average intake of the population is below the recommendations. The aim of this study, which involved probabilistic, mathematical and statistical modelling, was to understand, for the first time, how fibre fortification in a broad array of food categories could impact the diet and health status of Chinese consumers. DESIGN: A simulation-based approach was used to examine the potential impact of fibre fortification. The China Health and Nutrition Survey dataset was used to evaluate intakes of DF together with a dietary intake mathematical model. Commercially manufactured foods and beverages eligible for fibre fortification were identified and a total of 296 food and beverages were selected for fibre fortification calculation. Foods and beverages eligible for fibre fortification and the concentration of fibre used at intervention were identified based on Chinese legislations and regulations of nutrition label claims. Populations who meet the dietary reference values of fibre fortification have their health outcomes such as weight, cardiovascular disease (CVD) and type 2 diabetes risk quantified prefibre and postfibre reformulation as per published studies. RESULTS: The simulated fibre fortification intervention model has shown that the mean DF intake increased by 13.28%, from 12.8 g/day of baseline to 14.5 g/day, leading to an increase of 48% (from 6.85% to 10.13%) and 54% (from 14.22% to 21.84%) of the adult and children population, respectively, achieving the recommended fibre guidelines. Additionally, 234 diabetes cases per day (85 340 cases per year) as well as 73 065 deaths secondary to CVD could also potentially be averted or delayed with the increase of DF intake via fibre fortification. CONCLUSIONS: This study provides a practical application implicating the potential public health benefits that could be achieved with food product reformulation.

Web-Based 24-Hour Dietary Recall Tool for Russian Adults and School-Aged Children: Validation Study.

BACKGROUND: Data on dietary intakes in Russian adults and children are assessed very infrequently primarily due to the time, cost, and burden to the participants for assessing dietary patterns. To overcome some of those challenges, the use of web-based 24-hour recall methods can be successfully used. OBJECTIVE: The study objective is to assess the extent of agreement between a self-administered and an interviewer-administered 24-hour dietary recall in Russian adults and school-aged children using an adaptation of a web-based 24-hour recall tool. METHODS: This web-based dietary assessment tool is based on a previously validated tool, which has been adapted to the Russian diet and language. A randomized 50% (n=97) of 194 participants initially completed a self-administered web-based dietary recall, followed by an interviewer-administered 24-hour dietary recall later that same day, and vice versa for the other 50% (n=97) of participants. Following at least 1 week wash-out period, during visit 2, participant groups completed the 2 dietary recalls in the opposite order. Statistical analysis was carried out on the intake results from both methods for the 2 recalls. Finally, an evaluation questionnaire on ease-of-use of the tool was also completed. RESULTS: In total, intakes of 28 nutrients and energy were analyzed in this study. The Bland-Altman analysis showed that between 98.4% and 90.5% of data points were within the limits of agreement among all age groups and nutrients analyzed. A "moderate to excellent" reliability between the 2 methods was observed in younger children. In older children, a "moderate to good" reliability was observed, with the exception of sodium. In adults, "moderate to excellent" reliability between both methods was observed with the exception of vitamins B1, B2, and B6, and pantothenic acid. The level of agreement between the categorization of estimates into thirds of the intake distribution for the average of the 2 days was satisfactory, since the percentages of participants categorized into the same tertile of intake were ˃50%, and the percentages of participants categorized into the opposite tertile of intake were <10%. The majority of respondents were very positive in their evaluation of the web-based dietary assessment tool. CONCLUSIONS: Overall, the web-based dietary assessment tool performs well when compared with a face-to-face, interviewer-administered 24-hour dietary recall and provides comparable estimates of energy and nutrient intakes in Russian adults and children. TRIAL REGISTRATION: ClinicalTrials.gov NCT04372160; https://clinicaltrials.gov/ct2/show/NCT04372160.

Contribution of base diet, voluntary fortified foods and supplements to micronutrient intakes in the UK.

The objective of the present study was to evaluate the contribution of voluntary fortified foods and supplements to reducing micronutrient shortfalls in the UK population. A secondary analysis of the UK National Diet and Nutrition Survey was conducted (2012/13-2013/14, N 2546, 1·5-95 years). Micronutrient intakes were derived from food consumption intake data and food composition data and calculated as the proportion below or above the Dietary Reference Values for males and females of different age groups, for those on a base diet only, users of fortified foods but no supplements and users of fortified foods and supplements. Of the population consuming a base diet only, 21-45 % and 5-29 % fell below the Estimated Average Requirement (EAR) for minerals and vitamins, respectively. About 3-13 % fewer consumers of fortified foods fell below the EAR for vitamins and minerals. Supplements barely reduced the prevalence of intakes below the EAR. Among supplement non-users and users, 99 and 96 % failed to meet the reference intakes for vitamin D. More women than men were at risk of inadequacies of micronutrient intakes. The prevalence of inadequacies declined with increasing age. Voluntary fortified foods but not supplements made a meaningful contribution to intakes of vitamin and minerals, without risk of unacceptably high intakes. These insights may help the UK to define approaches to address micronutrients of concern in vulnerable groups.

Fibre and micronutrient intakes among fruit juice consumers and non-consumers in the UK and France: Modelling the effects of consumption of an orange pomace juice product.

BACKGROUND: Fruit intake, including consumption of 100% fruit juice, is generally associated with a better diet quality and overall health. However, fruit and vegetable intakes are below recommendations in many countries. METHODS: The present study examined fruit juice intake and total energy and nutrient intakes according to juice consumption or non-consumption in participants in the National Dietary and Nutrition Survey Rolling Programme 2014-2016 in the UK (n = 2723) and the Individual and National Study on Food Consumption 2006-2007 (n = 4079) in France. Total energy and nutrient intakes were also estimated for scenarios in which orange juice with pomace was either added to the daily diet or replaced 100% orange juice or beverages containing fruit juice. RESULTS: Fruit juice consumers had higher intakes of fruits and vegetables than non-consumers, were more likely to reach 5-a-day targets for fruit and vegetable consumption, and had significantly higher intakes of folate, vitamin C, potassium, magnesium, and fibre. Juice consumers also had higher total energy and sugar intakes, but lower body mass index than non-juice consumers. Modelling consumption of orange juice with pomace increased fibre and potassium intakes in orange juice consumers, and also increased fibre, most micronutrients, and 5-a-day achievements in non-juice consumers. CONCLUSIONS: These national survey results demonstrate that fruit juice consumers in the UK and France had higher intakes of fruits and vegetables than fruit juice non-consumers, and significantly higher intakes of several micronutrients and fibre. Furthermore, modelling of consumption of orange juice with pomace increased fibre and select micronutrient intakes, particularly among fruit juice non-consumers.

Estimating the potential public health impact of fibre enrichment: a UK modelling study.

For improving human health, reformulation can be a tool as it allows individuals to consume products of choice while reducing intake of less desirable nutrients, such as sugars and fats, and potentially increasing intake of beneficial nutrients such as fibre. The potential effects of reformulating foods with increased fibre on diet and health need to be better understood. The objective of this statistical modelling study was to understand how fibre enrichment can affect the diet and health of consumers. The UK National Diet and Nutrition Survey datasets from 2014 to 2015 and 2015 to 2016 were utilised to evaluate intakes of fibre and kilocalories with a dietary intake model. Foods and beverages eligible for fibre enrichment were identified (n 915) based on EU legislation for fibre content claims. Those people who meet dietary reference values and fibre enrichment health outcomes such as weight, CVD and type 2 diabetes risk reductions were quantified pre- and post-fibre reformulation via Reynolds et al., D'Agostino et al. and QDiabetes algorithms, respectively. The fibre enrichment intervention showed a mean fibre intake of 19·9 g/d in the UK, signifying a 2·2 g/d increase from baseline. Modelling suggested that 5·9 % of subjects could achieve a weight reduction, 72·2 % a reduction in cardiovascular risk and 71·7 % a reduced risk of type 2 diabetes with fibre fortification (all Ps ≤ 0·05). This study gives a good overview of the potential public health benefits of reformulating food products using a straightforward enrichment scenario.

Pulse Intake Improves Nutrient Density among US Adult Consumers.

The objective was to examine trends in pulse (dry beans, dry peas, chickpeas and lentils) intake over a 10-year period and to compare nutrient intakes of pulse consumers and non-consumers to better understand the impact of pulse consumption on diet quality in the US population. NHANES 2003-2014 data for respondents (≥19 years) with 2 days of intake was used to evaluate trends in pulse intake. Pulse consumers were identified as those NHANES respondents who consumed pulses on one or both days. Differences in energy adjusted nutrient intakes between non-consumers and consumers were assessed. There were no significant trends in pulse intakes for the total population or for pulse consumers over the 10-year period. In 2013-2014, approximately 27% of adults consumed pulses with an intake of 70.9 ± 2.5 g/day over 2 days, just slightly <0.5 cup equivalents/day. At all levels of consumption, consumers had higher (p < 0.01) energy adjusted intakes of fiber, folate, magnesium. Higher energy adjusted intakes for potassium, zinc, iron and choline and lower intakes of fat were observed for consumers than for non-consumers at intakes ≥69.4 ± 1.01 g/day. These data suggest that pulse consumption in the US population may result in better diet quality with diets that are more nutrient dense than those without pulses.

Impact of sociodemographic factors on the consumption of tubers in Brazil.

BACKGROUND: Although tubers play a significant role in Brazilian agriculture, very little is known about the intake of tubers among the Brazilian population. The objective of this study was to characterize the intake of tubers across Brazil. The types of tubers consumed were quantified, and the impact of geographic and sociodemographic factors was assessed. METHODS: This cross-sectional study is based on dietary intake data of 33,504 subjects obtained from the Brazilian National Dietary Survey. All tuber containing foods were identified, and the contribution of different tubers to overall tuber consumption in Brazil was quantified. Descriptive analyses assessed the impact of macroregion and sociodemographic characteristics on tuber consumption, and differences in intake were assessed using statistical tests. Lastly, the dietary intakes of tuber consumers and non-consumers were compared after adjusting for energy and covariates to determine if there were any major differences in dietary intakes between the two groups. RESULTS: Fifty-five percent of the Brazilian population consumed tubers, which differed by macroregion. The intake of tubers among consumers also differed between macroregions. Overall, rural areas reported significantly higher mean daily intakes of tubers (122 g/day) among tuber consumers than urban areas (95 g/day). Mandioca and potato were the most commonly consumed tubers (59 and 43% prevalence, respectively, on any of the 2 days), while the highest daily intakes amongst tuber consumers across Brazil were noted for sweet potato (156 g/day) and potato (95 g/day). On a macroregion level, among tuber consumers, mandioca had the highest prevalence of consumption in the North (94%), Northeast (83%), and Central-West (68%), while consumption of potatoes was most prevalent in the Southeast (63%) and South (62%). Compared to women, small but significantly higher tuber intakes were noted for males (108 vs. 85 g/day). There were no significant differences in intakes among income quintiles. After adjusting for energy and other covariates, nutrient intakes between tuber and non-tuber consumers were not meaningfully different, with the exception of sodium (+ 6.0% comparing non-tuber to tuber consumers), iron (+ 6.1%), zinc (+ 5.7%), vitamin C (+ 8.3%), riboflavin (+ 9.0%), and folate (+ 7.9%). CONCLUSIONS: Tuber consumption is influenced by regional and sociodemographic characteristics of the Brazilian population. When looking at energy-adjusted nutrient intakes, diets of tuber consumers have resulted in somewhat lower intakes of some micronutrients, namely riboflavin, folate, vitamin C, iron, sodium, and zinc.

Predictive modelling of the exposure to steviol glycosides in Irish patients aged 1-3 years with phenylketonuria and cow's milk protein allergy.

Children with Phenylketonuria (PKU) and severe cow's milk protein allergy (CMPA) consume prescribed, specially formulated, foods for special medical purposes (FSMPs) as well as restricted amounts of normal foods. These patients are exposed to artificial sweeteners from the consumption of a combination of free and prescribed foods. Young patients with PKU and CMPA have a higher risk of exceeding acceptable daily intakes (ADI) for additives than age-matched healthy children. A predictive modelling approach has been adapted successfully to assess the additive exposure of young patients with PKU and CMPA to artificial sweeteners. Steviol glycosides (E960) are at various stages of regulatory approval for the various food categories in the EU but are not as yet permitted for use in products intended for young children. The aim of this study was to predict potential steviol glycoside exposure in young children with PKU and CMPA considering the potential for future provisions for the use of this sweetener. The recent introduction of steviol glycosides means that no exposure data are available for children with CMPA and PKU. Food consumption data were derived from the food consumption survey data of healthy young children in Ireland from the National Preschool and Nutrition Survey (NPNS, 2010-11). Specially formulated amino acid-based FSMPs are used to replace whole or milk protein foods and were included in the exposure model to replace restricted foods. The recommendations to ensure adequate protein intake in these patients were used to determine FSMP intake. Exposure assessment results indicated that the maximum permitted level (MPL) for FSMPs would warrant careful consideration to avoid exposures above the ADI. These data can be used to inform recommendations for the medical nutrition industry.

Longitudinal modelling of the exposure of young UK patients with PKU to acesulfame K and sucralose.

Artificial sweeteners are used in protein substitutes intended for the dietary management of inborn errors of metabolism (phenylketonuria, PKU) to improve the variety of medical foods available to patients and ensure dietary adherence to the prescribed course of dietary management. These patients can be exposed to artificial sweeteners from the combination of free and prescribed foods. Young children have a higher risk of exceeding acceptable daily intakes (ADI) for additives than adults, due to higher food intakes per kg body weight. Young patients with PKU aged 1-3 years can be exposed to higher levels of artificial sweeteners from these dual sources than normal healthy children and are at a higher risk of exceeding the ADI. Standard intake assessment methods are not adequate to assess the additive exposure of young patients with PKU. The aim of this study was to estimate the combination effect on the intake of artificial sweeteners and the impact of the introduction of new provisions for an artificial sweetener (sucralose, E955) on exposure of PKU patients using a validated probabilistic model. Food consumption data were derived from the food consumption survey data of healthy young children in the United Kingdom from the National Diet and Nutrition Survey (NDNS, 1992-2012). Specially formulated protein substitutes as foods for special medical purposes (FSMPs) were included in the exposure model to replace restricted foods. Inclusion of these protein substitutes is based on recommendations to ensure adequate protein intake in these patients. Exposure assessment results indicated the availability of sucralose for use in FSMPs for PKU leads to changes in intakes in young patients. These data further support the viability of probabilistic modelling as a means to estimate food additive exposure in patients consuming medical nutrition products.

eBASIS (Bioactive Substances in Food Information Systems) and Bioactive Intakes: Major Updates of the Bioactive Compound Composition and Beneficial Bioeffects Database and the Development of a Probabilistic Model to Assess Intakes in Europe.

eBASIS (Bioactive Substances in Food Information Systems), a web-based database that contains compositional and biological effects data for bioactive compounds of plant origin, has been updated with new data on fruits and vegetables, wheat and, due to some evidence of potential beneficial effects, extended to include meat bioactives. eBASIS remains one of only a handful of comprehensive and searchable databases, with up-to-date coherent and validated scientific information on the composition of food bioactives and their putative health benefits. The database has a user-friendly, efficient, and flexible interface facilitating use by both the scientific community and food industry. Overall, eBASIS contains data for 267 foods, covering the composition of 794 bioactive compounds, from 1147 quality-evaluated peer-reviewed publications, together with information from 567 publications describing beneficial bioeffect studies carried out in humans. This paper highlights recent updates and expansion of eBASIS and the newly-developed link to a probabilistic intake model, allowing exposure assessment of dietary bioactive compounds to be estimated and modelled in human populations when used in conjunction with national food consumption data. This new tool could assist small- and medium-sized enterprises (SMEs) in the development of food product health claim dossiers for submission to the European Food Safety Authority (EFSA).

Probabilistic modelling to assess exposure to three artificial sweeteners of young Irish patients aged 1-3 years with PKU and CMPA.

The choice of suitable normal foods is limited for individuals with particular medical conditions, e.g., inborn errors of metabolism (phenylketonuria - PKU) or severe cow's milk protein allergy (CMPA). Patients may have dietary restrictions and exclusive or partial replacement of specific food groups with specially formulated products to meet particular nutrition requirements. Artificial sweeteners are used to improve the appearance and palatability of such food products to avoid food refusal and ensure dietary adherence. Young children have a higher risk of exceeding acceptable daily intakes for additives than adults due to higher food intakes kg-1 body weight. The Budget Method and EFSA's Food Additives Intake Model (FAIM) are not equipped to assess partial dietary replacement with special formulations as they are built on data from dietary surveys of consumers without special medical requirements impacting the diet. The aim of this study was to explore dietary exposure modelling as a means of estimating the intake of artificial sweeteners by young PKU and CMPA patients aged 1-3 years. An adapted validated probabilistic model (FACET) was used to assess patients' exposure to artificial sweeteners. Food consumption data were derived from the food consumption survey data of healthy young children in Ireland from the National Preschool and Nutrition Survey (NPNS, 2010-11). Specially formulated foods for special medical purposes were included in the exposure model to replace restricted foods. Inclusion was based on recommendations for adequate protein intake and dietary adherence data. Exposure assessment results indicated that young children with PKU and CMPA have higher relative average intakes of artificial sweeteners than healthy young children. The reliability and robustness of the model in the estimation of patient additive exposures was further investigated and provides the first exposure estimates for these special populations.

Nutrient intakes and iron and vitamin D status differ depending on main milk consumed by UK children aged 12-18 months - secondary analysis from the Diet and Nutrition Survey of Infants and Young Children.

Nutrition in the second year is important as this is a period of rapid growth and development. Milk is a major food for young children and this analysis evaluated the impact of the type of milk consumed on nutrient intakes and nutritional status. Data from the Diet and Nutrition Survey of Infants and Young Children were used to investigate the intakes of key nutrients, and Fe and vitamin D status, of children aged 12-18 months, not breastfed, and consuming >400 g/d fortified milk (n 139) or >400 g/d of whole cows' milk (n 404). Blood samples from eligible children for measurement of Hb (n 113), serum ferritin and plasma 25-hydroxyvitamin D (25(OH)D) concentrations (n 105) were available for approximately 20 % of children. Unpaired Mann-Whitney tests were used to compare nutrient intakes and status between consumers of fortified and cows' milk. Mean daily total dietary intakes of Fe, Zn, vitamin A and vitamin D were significantly higher in the fortified milk group. Mean daily total dietary intakes of energy, protein, Ca, iodine, Na and saturated fat were significantly higher in the cows' milk group. Hb was not different between groups. The fortified milk group had significantly higher serum ferritin (P = 0·049) and plasma 25(OH)D (P = 0·014). This analysis demonstrates significantly different nutrient intakes and status between infants consuming >400 g/d fortified milk v. those consuming >400 g/d whole cows' milk. These results indicate that fortified milks can play a significant role in improving the quality of young children's diets in their second year of life.