The Evolution of Science and Regulation of Dietary Supplements: Past, Present, and Future.

Dietary supplement use in the United States is widespread and increasing, especially among certain population groups, such as older Americans. The science surrounding dietary supplements has evolved substantially over the last few decades since their formal regulation in 1994. Much has been learned about the mechanisms of action of many dietary supplement ingredients, but the evidence on their health effects is still building. As is true of much nutrition research, there are many studies that point to health effects, but not all are at the level of scientific evidence (e.g., randomized controlled interventions), rigor, or quality needed for definitive statements of efficacy regarding clinical endpoints. New technologies and approaches are being applied to the science of dietary supplements, including nutrigenomics and microbiome analysis, data science, artificial intelligence, and machine learning - all of which can elevate the science behind dietary supplements. Products can contain an array of bioactive compounds derived from foods as well as from medicinal plants, which creates enormous challenges in data collection and management. Clinical applications, particularly those aimed at providing personalized nutrition options for patients, have become more sophisticated as dietary supplements are incorporated increasingly into clinical practice and self-care. The goals of this paper are to provide historical context for the regulation and science of dietary supplements, identify research resources, and suggest some future directions for science in this field.

Assessing the relative validity of a web-based self-administered 24-hour dietary recall in a Canadian adolescent's population.

BACKGROUND: Healthy eating habits at a young age are crucial to support growth and development and good general health. In this context, monitoring youth dietary intakes adequately with valid tools is important to develop efficient interventions and identify groups that are more at risk of inadequate intakes. This study aimed to assess the relative validity of the self-administered web-based 24-h dietary recall (R24W) for evaluating energy and nutrient intakes among active adolescents. METHODS: Participants were invited to complete one interviewer-administered 24-h dietary dietary recall and the R24W on up to three occasions within one month. A total of 272 French-speaking active adolescents aged 12 to 17 years from the province of Québec were invited to complete three R24W and one interview-administered 24-h recall. Student's t-test and correlations were conducted on sex-adjusted data. Percent differences, cross-classification (percentage of agreement), weighted Kappa and Bland-Altman plots were calculated. RESULTS: Mean (SD) energy intake from the R24W was 8.8% higher than from the interview-administered 24-h dietary recall (2558 kcal ± 1128 vs. 2444 kcal ± 998, p < 0.05). Significant differences in mean nutrient intake between the R24W and the interview-administered 24-h dietary recall ranged from 6.5% for % E from fat (p < 0.05) to 25.2% for saturated fat (p < 0.001), i.e., higher values with R24W. Sex-adjusted correlations were significant for all nutrients except for % E from proteins and thiamin (range: 0.24 to 0.52, p < 0.01). Cross-classification demonstrated that 36.6% of the participants were classified in the same fourth with both methods, 39.6% in the adjacent fourth, and 5.7% misclassified. Bland-Atman plots revealed proportional bias between the two methods for 7/25 nutrients. Completing at least two recalls with the R24W increased the precision of intake estimates. CONCLUSION: These data suggest that the R24W presents an acceptable relative validity compared to a standard interview-administered 24-h recall for estimating energy and most nutrients in a cohort of French-speaking adolescents from the province of Québec.

South East Asian Nutrition Surveys II (SEANUTS II) Thailand: Triple burden of malnutrition among Thai children aged 6 months to 12 years.

OBJECTIVE: This study assessed nutritional status among Thai children using anthropometry, dietary intakes, and micronutrient status. DESIGN: Cross-sectional survey with multi-stage cluster sampling. Body weight and height were measured in all children. Dietary intakes were assessed using 24-hour dietary recall. Biochemical assessment was performed in one-third of the children. SETTING: The study was conducted in Thailand's four geographical regions and Bangkok. PARTICIPANTS: 3478 Thai children aged 0.5-12.9 years. RESULTS: Stunting showed a downward trend by age group and was most prevalent among infants and toddlers. Overweight and obesity showed a significant upward trend by age group, location, and sex, and was highest among children aged 7-12.9 years. Risks of inadequate micronutrient intakes (calcium, iron, zinc, vitamins A, C, and D) were high (53.2-93.6%). Prevalence of zinc and mild vitamin A deficiencies were low; vitamin D and B12 deficiencies were nil. Vitamin D insufficiency was significantly higher in the urban area and among girls aged 7-12.9 years. Anemia was very high in infants and toddlers (56.6 and 35.2%), but showed a significant downward trend by age group. There was an overall high prevalence of iron deficiency without anemia (25%) versus iron deficiency anemia (4.2%) among children aged 4-12.9 years old. CONCLUSIONS: The high prevalence of stunting and anemia among children aged 1-3.9 years and overweight and obesity among children aged 7-12.9 years requires continued attention. While prevalence of biochemical micronutrient deficiencies was not high (except for iron), high prevalence of dietary inadequacies for several micronutrients warrants further in-depth investigations.

Plant-Based Dietary Indices in Relation to Nutrient and Food Group Intakes in Preschool-Aged Children.

Dietary guidance promotes plant-based foods, yet minimal research has examined intake in children. This study examined plant-based food intake in preschool-aged children using plant-based dietary index (PDI) metrics and related these metrics to nutrient and food group intakes. Dietary data were collected from preschool-aged children (n = 283, 3.45 ± 1.22 years) from the Guelph Family Health Study at baseline using the Automated Self-Administered 24-Hour Dietary Assessment Tool. Food intake servings were assigned to 16 food groups for calculation of overall PDI (oPDI), healthful PDI (hPDI), and less healthful (lhPDI) scores and summarized into tertiles for energy-adjusted comparisons. For oPDI, participants in the highest vs. lowest tertile had higher intakes of nutrients and food groups to encourage (e.g., dietary fiber, fruits) as well as lower intakes of nutrients to encourage (e.g., calcium, vitamin D). For hPDI, participants in the highest vs. lowest tertile had higher intakes of nutrients and food groups to encourage and lower intakes of those to limit (e.g., saturated fat, sweets and desserts). For lhPDI, participants in the highest vs. lowest tertile had higher intakes of nutrients and food groups to limit and lower intakes of those to encourage. These results can inform dietetic practice for dietary guidance that promotes plant-based foods in children.

Breakfast consumption trends among young Australian children aged up to 5 years: results from InFANT program.

Breakfast is considered a healthy dietary habit which can track over time from childhood to adulthood. The breakfast meal has the potential to improve daily dietary quality, particularly if it includes a range of food groups and adequate nutrient intakes. However, research on breakfast consumption trends among young Australian children aged up to 5 years is currently limited. This study assessed children's usual breakfast food group and nutrient intakes at ages 1.5 (n = 369), 3.5 (n = 242), and 5.0 (n =240) years using three 24-hour dietary recalls from the Melbourne InFANT program. Tracking of food groups at breakfast across the three ages was assessed by Pearson correlation of energy-adjusted food intake residuals. The main food groups consumed at breakfast were grains, milk/alternatives and discretionary items, with vegetables rarely consumed at any age. Our study found that while breakfast contributed about 20% of total daily energy, this provided 20%-29.1% of total daily intake across all ages for carbohydrates, total sugars, calcium and potassium. For the contribution to daily recommendations, breakfast contributed more than about a third of daily recommended intakes for some micronutrients (e.g., iron, calcium and zinc), and a large proportion (over 40%) of sodium intake. Children consumed 11.9% -15.2% of their energy at breakfast from saturated fat, which is higher than the recommended total energy contribution of saturated fat (no more than 10% from saturated fat). For tracking of most food groups and nutrients, tracking was found to be low or moderate over time. Given the contribution that breakfast can make to ensure children achieve their daily dietary intakes, early interventions for young Australian children should focus on practical strategies to increase vegetable intake while reducing sodium and saturated fat intake at breakfast.

Trends in Mean Energy and Nutrient Intakes in Japanese Children and Adolescents: The National Health and Nutrition Survey, 1995-2019.

This study aimed to describe the national trends in mean energy and nutrient intakes in Japanese children and adolescents from 1995 to 2019. We used data obtained from the National Health and Nutrition Survey and included 54,871 participants aged 1-19 years. The dietary intake was estimated using a 1-day, semi-weighed, household-based, dietary record. The trends of mean energy and nutrient intakes were analyzed using the Joinpoint Regression Program. A declining trend in the mean energy intake was observed in toddlers aged 1-6 years, school girls aged 7-14 years, and adolescent girls aged 15-19 years, while the mean energy intake from protein, fat, and carbohydrates changed little over time. The mean salt equivalent showed a decreasing trend in all age groups, although the 2019 mean values were above the tentative dietary goal for preventing lifestyle-related diseases, especially in adolescent boys. Declining trends in mean vitamin (vitamin A, vitamin B12, folate, vitamin D, and vitamin K) and mineral (calcium, iron, and copper) intakes were observed, while trends in the mean vitamin B6 and zinc intakes were unchanged since 2001. Continuous monitoring of dietary intake and further research are required to raise awareness of unhealthy diet habits and to improve the food environment for the healthy growth and development of children and adolescents.

Dietary Energy and Nutrient Intake of Healthy Pre-School Children in Hungary.

Diet in the early years of life may influence the development of chronic diseases later on. The aim of the present study was to investigate the dietary intake of 2- to 6-year-old Hungarian children. In 2013 and subsequently in 2016, cross-sectional surveys were conducted among parents of healthy children attending kindergarten in Hungary. We used a three-day food diary to record quantitative data of all the nutrients consumed by the children on two working days and one weekend day. The dietary intakes were compared to both the Hungarian recommended dietary allowances and the European Food Safety Authority recommendations. The nutritional data of altogether 186 children in 2013 and 556 children in 2016 were analyzed. The total energy and carbohydrate intake was appropriate. We observed high sugar intake in every fifth child. Protein, fat and cholesterol intake, as well as the intake of sodium, potassium and phosphorus, were high. The consumption of calcium and vitamin D was low. Water consumption was not satisfying. The present results underline the need for interventions starting early in life in order to ameliorate nutrient intake during childhood, possibly impacting long-term health outcomes.

Assessment of the Use of Food Supplements by Military Personnel: Study Protocol and Results.

Due to their specific mode of operation, military personnel are challenged physically as well as mentally. In most countries, the use of food supplements by military personnel is not regulated, and a high prevalence of supplementation is expected. However, data on this are scarce or very limited, without insights into the importance of supplementation for the intake of bioactive substances. Our goal was, therefore, to develop a study protocol to enable an assessment of the prevalence of using food supplements and an estimate of the contribution of supplementation practices to the dietary intake of specific nutrients and other compounds. The protocol was tested in a study of Slovene Armed Forces (SAF) personnel. Data were collected using an anonymous questionnaire in a sample of 470 participants from different military units-about half from the barracks located across the country, and the other half returning from military operations abroad. To provide meaningful results, we recorded the use of food supplements and functional foods available in single-sized portions (i.e., energy drinks, protein bars, etc.). Altogether, 68% of the participants reported supplementation, most commonly with vitamin, mineral, and protein supplements. Military rank, participation status in military operations, and physical activity were the main determinants of the specific supplements used. Surprisingly, a lower prevalence of overall and protein supplementation was observed in subjects returning from military operations abroad (62 vs. 74%) than in personnel stationed in barracks across Slovenia; however, the frequency of the use of energy drinks and caffeine supplements was higher in this population (25 vs. 11%). The study design allowed for estimations of the daily intake of supplemented bioactive compounds. We describe the challenges and approaches used in the study to support similar studies in the future and within other populations.

Nutrient Adequacy in Endurance Athletes.

Proper nutrition is critical for optimal performance in endurance athletes. However, it is unclear if endurance athletes are meeting all their energy and nutrient needs. We examined if endurance athletes are meeting their nutritional requirements and if this differed by sex. Ninety-five endurance athletes (n = 95; 50.5% men; 34.9 ± 12.9 y) participated in the study. Dietary intake was evaluated using the 24 h dietary recall method. Energy and nutrient intakes were calculated using the ESHA Food Processor Diet Analysis Software and compared against reference nutrient intakes. Endurance athletes did not consume the recommended amount of energy (76.8% of athletes), carbohydrates (95.8%), linoleic acid (75.8%), α-linolenic acid (ALA) (77.9%), eicosatetraenoic and docosahexaenoic acid (96.8%), dietary fiber (49.5%), vitamins D (93.7%), E (71.6%), and K (54.7%), folate (54.7%), pantothenic acid (70.5%), biotin (83.2%), manganese (58.9%), magnesium (56.8%), chromium (91.6%), molybdenum (93.7%), choline (85.3%), and potassium (56.8%), and consumed too much saturated fat (50.5%) and sodium (94.7%) than recommended. Fisher's Exact test showed that the requirements for dietary fiber (70.8% vs. 27.7%), ALA (87.5% vs. 68.1%), and total water (70.8% vs. 44.7%) were not met by more men versus women (p < 0.05). The needs for protein (70.2% vs. 25%) and vitamin B12 (46.8% vs. 22.9%) were not met by more women compared to men (p < 0.05). These findings need to be confirmed by a larger study.

Association between Different Types of Exercise and Intake of Nutrients including Carbohydrate, Fat, Protein, and B Vitamins in Young Adults.

PURPOSE: This cross-sectional study aimed to investigate the association between different types of exercise and nutrient intake to provide a basis for promoting the overall health of young adults. METHODS: A total of 427 young adults (217 women) aged 21 to 35 were recruited. Participants self-reported time spent (min/week) in endurance exercise, resistance exercise, sports, walking, and other structured physical activity (PA). Nutrient intake was determined via telephone-administered 24 h recalls. RESULTS: Resistance exercise was positively associated with intake of protein, vitamins B2, B3, B5, B6, and B12 and the percentage of total calories from protein (PCT-PRO), and negatively associated with the percentage of total calories from carbohydrate (PCT-CHO) (p < 0.05). Time spent in aerobic exercise was positively associated with fiber, pectin, and vitamin B6 intake, and negatively associated with PCT-PRO (p < 0.05). Time spent exercising was negatively associated with fiber and pectin intake (p < 0.05). Time spent performing other structured PA was positively associated with pectin intake (p < 0.05). Participants' total exercise time was positively associated with intake of vitamins B2, B5, B12, and PCT-Fat, PCT-PRO, and negatively associated with PCT-CHO (p < 0.05). CONCLUSION: The results showed an association between various exercise types and specific nutrients. It may be worthwhile to point out the negative association of exercise with CHO intake, which may need to be examined more closely in active young adults. In addition, the supplementation of B vitamins and pectin may be beneficial for their exercise performance and post-exercise recovery.

Fresh Beef and Lamb Consumption in Relation to Nutrient Intakes and Markers of Nutrition and Health Status among the Population Aged 5-90 Years in Ireland.

The dietary role of meat is under scrutiny for health and environmental reasons, yet a growing body of evidence proposes that advice to limit red meat consumption is unnecessarily restrictive. The aim of this study was to investigate the role of 'fresh beef and lamb' in the diet of the population (5-90 years) in Ireland and its association with markers of nutrition and health status. Analyses are based on data from three nationally representative dietary surveys in the Republic of Ireland. Dietary intake data were estimated using food records, and nutrient intakes were estimated based on UK and Irish food composition tables. Biochemical samples were collected and analysed using standard procedures. 'Fresh beef and lamb' (defined as beef/lamb that had not undergone any preserving process other than chilling/freezing/quick-freezing) was consumed by 68-84% of the population and intakes ranged from 19 to 43 g/d across age groups. It made important contributions to intakes of protein, monounsaturated fat, vitamins D, B12, niacin, iron and zinc while also contributing relatively small proportions of total fat, saturated fat and salt. Higher consumption of 'fresh beef and lamb' was associated with higher intakes of protein, niacin, vitamins B6, B12, zinc and potassium (but also total fat) and lower intakes of carbohydrate and total sugars (but also dietary fibre). In adults, older adults and WCBA, higher consumption of 'fresh beef and lamb' was not associated with increased risk factors of cardio-metabolic diseases nor was it associated with better or poorer nutritional status for vitamins D, B12 or iron. This study adds to the evidence base on the contribution of 'fresh beef and lamb' in the diet and may be useful to policymakers updating guidance for healthy diets from sustainable food systems.

Are Front-of-Pack Nutrition Labels Influencing Food Choices and Purchases, Diet Quality, and Modeled Health Outcomes? A Narrative Review of Four Systems.

Front-of-Pack Nutrition labels (FOPNLs) aim to improve consumers' food purchases and prompt product reformulation by the food and beverage industry. Despite their widespread use, the effectiveness of FOPNL in achieving these goals is still a matter of debate. This review has gathered 65 original studies exploring the performances of four widely used FOPNLs (Multiple Traffic Light, Warning signs, Nutri-Score and Health Star Rating). Although FOPNLs have been associated with healthier food purchases, the magnitude of improvements was small and dependent on study settings. Any associated health effects were modeled rather than observed. None of the four FOPNLs clearly outperformed the other ones on any outcome. Few studies dealt with the impact of FOPNL on product reformulation. Some of those studies, but not all, found small reductions in energy, sodium, sugar and saturated fat content of foods in some food categories. Although global trends point to a small favorable effect of FOPNL, this conclusion is subject to caution since the evidence is inconsistent and comes from a wide variety of contexts and study designs. There remain numerous research gaps, notably with regard to the optimal characteristics of FOPNLs, the durability of FOPNL effects on consumer behaviors, and any possible unexpected consequences.

Dietary intake patterns, nutrient adequacy and associated factors in a multi-ethnic Caribbean population.

Background: Diet is a significant contributor to health and wellbeing of individuals. Aim: In this study we investigated patterns of dietary intakes, levels of nutrient inadequacies and associated sociodemographic, anthropometric and lifestyle factors among adults in Trinidad and Tobago. Method: The study was cross-sectional in nature. A convenience sample of 11783 persons from districts throughout Trinidad and Tobago completed a self-administered questionnaire comprising socio-demographic and lifestyle items. Anthropometry was self-reported with 15% of participants having measurements done according to recommended procedures. Dietary patterns were determined by principal component analysis (PCA) while nutrient intakes and adequacy were assessed using the NutriGenie 7.0 software and nutrient adequacy ratio (MAR) respectively. Foods were categorised as unprocessed/minimally processed and processed/ultra-processed. The University of The West Indies Ethics Committee approved the study. Results: Approximately 72.5% of participants met the Goldberg criteria for plausible reporting. The three predominant dietary patterns 'Typical', 'Fruits and Vegetables', and 'High Fat' explained 45% of the total variance in foods consumed. Processed/ultra-processed foods accounted for most of the energy (80%) and nutrients consumed. Nutrient inadequacies were observed for potassium, vitamins B12, D, E, K, fibre, magnesium; and iron among females. The mean adequacy ratio (MAR) for participants was 67%. MAR was positively associated with predominant dietary patterns independent of socioe demographic and lifestyle factors (p < 0.001). Conclusion: Irrespective of their nature, the predominant dietary pattern was associated with nutrient adequacy among participants. Reducing the risk of inadequate nutrient intakes may be addressed by increasing availability, access and consumption of appropriate sources of these micronutrients.

Validation and Comparison of Nutrient Intakes from Two Dietary Questionnaires Developed for the Multiethnic Cohort Study.

BACKGROUND: Quantitative food frequency questionnaires (QFFQs) are often used to measure dietary intakes in large cohort studies but the impact of updating these questionnaires over time is not often examined. OBJECTIVE: This study compared nutrient intakes estimated from two different QFFQs to each other and to intakes calculated from three 24-hour dietary recalls (24HDRs). DESIGN: This study used a cross-sectional design. PARTICIPANTS/SETTING PARTICIPANTS: Participants (N = 352) were members of the Multiethnic Cohort Study from five racial and ethnic groups (African American, Japanese American, Latino American, Native Hawaiian, and White) who lived in Hawaii and Los Angeles. They were recruited in 2010 and asked to complete two QFFQs, two months apart, and three 24HDRs in the time between completion of the QFFQs. One questionnaire had been developed for a baseline survey (baseline QFFQ) at the start of the Multiethnic Cohort Study during 1993-1996, and the other was updated for a follow-up study 10 years later (10-year QFFQ). MAIN OUTCOME MEASURES: Daily intakes of energy and nine nutrients were estimated from both QFFQs, and from the average of three 24HDRs. STATISTICAL ANALYSES PERFORMED: Pearson's correlation coefficients were calculated between log-transformed nutrient intakes from each QFFQ and the 24HDRs and between the two QFFQs overall, by sex, and by race and ethnicity. RESULTS: Correlations for the 10-year QFFQ with the 24HDRs (average = 0.45) were higher than for the baseline QFFQ (average = 0.41), although the differences were not statistically significant. The increase in correlations was particularly pronounced for Native Hawaiian and African American participants. When absolute values were adjusted for energy intake, the average correlations were higher at 0.57 for the baseline QFFQ and 0.58 for the 10-year QFFQ overall and this pattern was seen in most racial and ethnic subgroups. The average correlations between the two QFFQs were 0.73 for both absolute intakes and nutrient densities overall. CONCLUSIONS: Correlations of nutrient intakes between the two QFFQs and 24HDRs were similar, and intakes from the two QFFQs were highly correlated. QFFQs updated for changes to the food supply may provide improved assessment for cohort studies that include diverse populations.

Review of recommended energy and nutrient intake values in Southeast Asian countries

@#This review summarises the officially published recommended energy and nutrient intake values in five Southeast Asia (SEA) countries namely Indonesia, Malaysia, Philippines, Thailand and Vietnam. The background information, general approaches and references used for setting up recommendations and the recommended intakes levels for energy, protein, fat and carbohydrate, dietary fibre, sugars,14 vitamins and 15 minerals of these countries were tabulated and compared. The recommended intake values show remarkable similarities in terms of approaches and principles taken, as well as references used as the basis for the recommendations development and the application of the recommendations in respective country. There are nevertheless some differences in age groupings, reference height and weight used, as well as the final recommendations of the intake levels for some nutrients, after adjustment to suit local situations. All five countries had provided recommendations in terms of recommended nutrient intakes (RNI) or recommended dietary allowance (RDA) for almost all the nutrients. Due to the limited availability of local data and resources, countries in the region have referred to several references, including those from Food and Agriculture Organization/World Health Organization (FAO/WHO) consultation report and recommendations from research organisations in United States and Europe and adapted the values for local uses. Opportunities should be created to enable closer dialogue and collaboration regarding future developments in nutrient recommendations for populations in the region. These could include consideration of establishing more appropriate nutrient recommendations and the call for setting up harmonised approaches to establishing recommended nutrient intake values for the region.

Suboptimal feeding practices and impaired growth among children in largely food insecure areas of north Wollo, Ethiopia.

In Ethiopia, information is limited about energy and micronutrient intakes from complementary foods consumed by children in Productive Safety Net Program districts. Therefore, we assessed feeding practices and intakes of energy and selected micronutrients from complementary foods of children aged 6-23 months in a food insecure rural area of Ethiopia. Energy and micronutrient intakes were estimated from multiple-pass 24 h recall. Data were collected using a structured questionnaire. Only 1⋅9 % of children in the age range 6-8 months met recommended minimum dietary diversity of ≥5 food groups; this value slightly increased to 4 and 10⋅1 % in the older age groups (9-11 months and 12-23 months, respectively). Overwhelmingly, none of the children (9-11 months) did get the minimum acceptable diet (Children receiving minimum acceptable diet were 4 and 2⋅6 % in 6-8 months and 12-23 months, respectively). The overall prevalence of stunting was 34 % in younger children (6-8 months) and 51 % in older children aged 12-23 months. Median energy and selected micronutrient intakes from complementary foods were below corresponding WHO recommendations assuming average breast-milk amount and composition. The worst shortfalls were for vitamins A and C and for Ca. In contrast, median iron, protein and niacin intakes and densities were above the WHO recommendation. Caretakers and community leaders in the study setting need nutrition education on IYCF-related practices and on the importance of men's involvement in IYCF. Ensuring the accessibility and affordability of animal source foods (ASFs), fruits and vegetables, and feasible complementary foods is critical to address the quality of complementary feedings. This can be achieved through promoting nutrition-sensitive agriculture such as poultry and home gardening in this setting.

Comparisons of Characteristics and Nutritional Inadequacies in Indonesian Older Adults Consuming or Refraining from Dairy Products.

BACKGROUND: Milk consumption in the Indonesian elderly population is among the lowest in the world, and two-thirds of the population are lactose intolerant. This might have an impact on energy and nutrient intakes. However, data on the prevalence of nutrient intake inadequacies in dairy users versus non-dairy users, as well as population characteristics, are lacking. Therefore we obtained data comparing nutritional inadequacies and characteristics of Indonesian older adults consuming or refraining from dairy products. METHODS: A cross-sectional study was conducted in 2021 as a part of the INA LACTASE study, involving 194 community-dwelling older adults in the outpatient geriatric clinic at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. We collected data on demographic and clinical characteristics as part of a routinely performed comprehensive geriatric assessment. A structured questionnaire was developed to categorize participants as dairy-or non-dairy users based on habitual dairy intake. Food records were collected to assess nutrient intakes. The prevalence of inadequacies of energy, macronutrients, and a selection of micronutrients (calcium, vitamin D, and vitamin B12) was calculated by comparing the reported mean intakes to the recommended dietary intakes of the Indonesian population (Indonesian RDA). Prevalence ratios were calculated to measure the association between dairy product consumption and the prevalence of nutrient inadequacies. RESULTS: We recruited 194 eligible participants. This study found that dairy users had a higher proportion of women, a higher monthly income, but a lower proportion of hypertension, diabetes mellitus, and dyslipidaemia in older adults consuming dairy products. We observed wide variability in energy and nutrient intakes, as well as a high prevalence of inadequacies for all dietary intake parameters, particularly micronutrients. Dairy users had a lower prevalence of micronutrient inadequacies than non-dairy users. The prevalence of vitamin D inadequacies in dairy users versus non-dairy users was 91.6% vs. 99.3% in men and 71.9% vs. 98.0% in women, respectively. Inadequate vitamin B12 intake was found in 60.6% of dairy users vs. 89.4% of non-dairy users in men and 65.5% vs.. 68.4% of women, respectively. The most pronounced difference was found in the prevalence of calcium intake inadequacies in dairy users vs. non-dairy users, which was 64.8% vs. 99.5% in men and 89.9% vs. 99.8% in women. We found statistically significant differences in the prevalence of calcium, vitamin D, and vitamin B inadequacies between dairy and non-dairy users. CONCLUSION: This study identified that dairy users had a higher monthly income and had a lower proportion of hypertension, diabetes mellitus, and dyslipidemia. In addition, we discovered a high prevalence of nutrient intakes inadequacies in Indonesian older adults, particularly among non-dairy users. Micronutrient inadequacies are major sources of concern, with statistically significant difference in calcium, vitamin D, and vitamin B12 prevalence of inadequacies.

Assessment of energy and nutrient intakes among undergraduate students attending a University in the North of England.

Background: Unhealthy diets are typical of university students and are often thought to be unrepresentative of the general population. The main aim was to determine the energy and nutrient intakes of a large cohort of undergraduate university students; and to compare to gender-specific dietary reference values (DRVs) and nutrient data from the general population. Methodology: Data was collected from 639 university students aged 18-24 years who completed 4-day diet diaries. The energy and nutrient intake was determined and percentage energy values calculated and compared with dietary reference values (DRVs) and the National Diet and Nutrition Survey (NDNS) and Family Food Statistics. Logistic regression methods were used to identify micronutrients functioning as predictors of exceeding DRVs. Results: Energy intakes were lower than the DRV. The percentage total energy values for protein, fat, saturated fat and carbohydrate exceeded DRVs but the percentage energy from alcohol was below the maximum 5%. The DRVs were met for vitamin C, thiamin, and sodium/salt. Iron and calcium intakes were met in males but not in females. Intakes for fibre and vitamin A were below the DRV. Student data was comparable to the NDNS, with the exception of alcohol, fibre, vitamin A, calcium and sodium/salt, which were all lower than the NDNS. Conclusions: This study contradicts the stereotypical assumption that students are following a high energy, fat, saturated fat, total sugars, salt and alcohol diet compared with the general population.

Significant Nutritional Gaps in Tibetan Adults Living in Agricultural Counties Along Yarlung Zangbo River.

Background: Dietary intake and nutritional assessing data from a representative sample of adult population living in an agricultural zone on Tibet Plateau are still lacking nowadays. This study aimed to assess the daily dietary intakes and respective food sources in 552 local residents (≥ 18 years old, 277 men and 275 women) living in 14 agricultural counties along the Yarlung Zangbo River on Tibet Plateau. Methods: Food consumption data were collected using a validated cultural-specific food frequency questionnaire that contained all local Tibetan foods and analyzed with three fixed factors: gender, age, and region. Nutrient intakes were calculated using Chinese food composition tables. Nutritional gaps and the percentages of participants who had inadequate and excessive nutrient intakes were calculated by estimated average requirement (EAR) cut-point methods. Results: Compared with the dietary reference intakes, 68.4% of nutrient intakes were inadequate. Fiber, Ca, I, Zn, Se, and vitamin (Va, Vc, and folic acid) intakes appeared to be particularly deficient. The dietary energy intake was 7838.8 ± 537.1 KJ/d, with 78 and 84% of EAR values for men and women, respectively. The dietary intakes of most nutrients were below the estimated energy requirement/EAR or adequate intake values, while more than 70% of the participants had excessive intake of carbohydrate, especially the elderly (aged ≥ 51 years). The nutritional gap of Cu was more than 300%. Almost 100% of the participants was vulnerable to fiber, Se, and Va shortfalls due to the deficiency in sole food sources. The top five food sources of Se intake were highland barley (34.2%), meat (13%), rice (12.4%), eggs (12.2%), and cultural-specific beverages (7.8%). Eggs (42.1%), tubers (62.2%), vegetables (66.4%), and highland barley (49.7%) were the first contributors of Va, Ve, Vc, and folic acid, respectively. Conclusion: The dietary intake of a large sample of Tibetan adult population living in agricultural counties of Tibetan Autonomous Region is alarmingly insufficient. Gender inequality is common, and regional difference is widespread due to rapid urbanization. Young Tibetan adults aged 18-30 years are particularly vulnerable to micronutrient shortfalls and currently facing the risk of nutrition-insecurity-related dietary inadequacy. The respondents who belong to the elderly category (≥51 years of age) are facing the risk of "double burden of malnutrition" characterized by the coexistence of undernutrition, including micronutrient deficiencies and overweight or obesity.

Scientific advice related to nutrient profiling for the development of harmonised mandatory front-of-pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods.

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver scientific advice related to nutrient profiling for the development of harmonised mandatory front-of-pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods. This Opinion is based on systematic reviews and meta-analyses of human studies on nutritionally adequate diets, data from the Global Burden of Disease framework, clinical practice guidelines, previous EFSA opinions and the priorities set by EU Member States in the context of their Food-Based Dietary Guidelines and associated nutrient/food intake recommendations. Relevant publications were retrieved through comprehensive searches in PubMed. The nutrients included in the assessment are those likely to be consumed in excess or in inadequate amounts in a majority of European countries. Food groups with important roles in European diets have been considered. The Panel concludes that dietary intakes of saturated fatty acids (SFA), sodium and added/free sugars are above, and intakes of dietary fibre and potassium below, current dietary recommendations in a majority of European populations. As excess intakes of SFAs, sodium and added/free sugars and inadequate intakes of dietary fibre and potassium are associated with adverse health effects, they could be included in nutrient profiling models. Energy could be included because a reduction in energy intake is of public health importance for European populations. In food group/category-based nutrient profiling models, total fat could replace energy in most food groups owing to its high-energy density, while the energy density of food groups with low or no fat content may be well accounted for by the inclusion of (added/free) sugars. Some nutrients may be included in nutrient profiling models for reasons other than their public health importance, e.g. as a proxy for other nutrients of public health importance, or to allow for a better discrimination of foods within the same food category.